© UNICEF/AFGHANISTAN00900D/Asad Zaidi CHAPTER- 4 …
Transcript of © UNICEF/AFGHANISTAN00900D/Asad Zaidi CHAPTER- 4 …
HYGIENE PROMOTIONC H A P T E R - 4
copy UNICEFAFGHANISTAN00900DAsad Zaidi
56 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
WHY PROMOTE HYGIENE IN EMERGENCIES
PRINCIPLES OF HYGIENE PROMOTION
DOING THE GROUNDWORK
GETTING THE MESSAGE RIGHT
COMMUNICATION ACTIONS FOR HYGIENE PROMOTION
MONITORING MILESTONES
PRACTICAL EXPERIENCES
RESOURCE BANK
HYGIENE PROMOTIONC H A P T E R - 4
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 57
Hygiene is the practice
of keeping oneself and
ones surroundings
clean especially in
order to prevent illness
or the spread of
disease Emergencies
create an environment
in which germs flourish
over crowding
traumatised immune systems poor (or no) access to facilities
latrines safe water and exposure to disease pathogens - all of which
endanger peoples health and survival
WHY PROMOTE HYGIENEIN EMERGENCIES
Research shows that hygienic practicescan have an equal or greater impact ondisease prevention than water supply andsanitation facilities Modern thinkingsuggests that the two must go hand-in-hand to effectively combat disease and toboost healthy sustainable hygienicbehaviours
What is hygienepromotionHygiene promotion empowers people toprevent disease It is the process ofinfluencing peoplersquos knowledge attitudesand practices and an agencyrsquos knowledge
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PAKISTAN A mother washes her daughterrsquos hands with soap and water near theirtemporary shelter
Common myths in hygienepromotion that you can avoid1 People are empty vessels into
which new ideas can simply bepoured
2 People will listen to me because
Im medically trained3 People can learn germ theory in a
few sessions at the health centre
4 Health education can reach largepopulations
5 Knowing means doing
Source Curtis V5
HYGIENE PRO
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58 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
F-DIAGRAM HOW DO PEOPLE CATCH DIARRHOEA 4and resources which together enable family members to avoid risky behavioursrelated to water use waste and excreta disposal and cleaning habits1
The key ingredients to effective hygiene promotion are A mutual sharing of information and knowledge Mobilising communities for concerted action Providing essential supplies and facilities
We can group hygiene promotion into three categories2
Reducing high-risk hygienic practices Promoting appropriate use and maintenance of facilities Promoting participation in programmes
Such a multi-pronged approach should enable the affected community to practicehygienic behaviours and stay healthy
The role of hygiene promotion in emergenciesPreventing diarrhoeal infection by promoting hygienic practices should be yourcommunication priority Number One in an emergency situation In camp situationsdiarrhoeal diseases can account from 25 to 40 percent of deaths in the acute phase of anemergency More than 80 percent of the deaths usually occur in children under 2 years
The F-diagram below illustrates the different routes diarrhoea microbes take from faecesto a person Interrupting the transmission chain thus should be your first priority
F-diagram How do people catch diarrhoea4
Faeces
Fingers
Flies
Food New host
Fields
Fluids
PB SB
SB
PB Primary barrierSB Secondary barrierAdapted from Kawata 1978
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 59
PRINCIPLES OFHYGIENE PROMOTIONIn emergency situations you have to
coordinate closely with all agencies
involved in relief work on a small
number of hygiene messages of
proven public health importance
Coordination of programme
communication activities avoids
duplication of efforts and wasting of time and resources - both of
the programmes and of the affected community Apply the following
essential principles to hygiene promotion
1 Focus on a small number of risk practicesTo control diarrhoeal disease your messages should highlight the priority hygienepractices hand wash with water and soap or when not available use ash aftercontact with faeces and safe disposal of adultsrsquo and childrenrsquos faeces to preventinfection and contamination ndash ie clear scattered faeces control open defaecationand shallow trench latrines repair toilet facilities andor build temporary family orcommunal latrines6
2 Involve specific participant groupsInvolve fathers mothers children older siblings opinion leaders and otherinfluential persons and groups in the affected community Public health promotersneed to identify primary child caregivers and those who influence and makedecisions for them Involve these influencers in the different stages of a healthpromotion initiative
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NEPAL Teaching proper hand washingtechniques in Pumdi Bhumdi 2004
HYGIENE PRO
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60 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
3 Identify the motives for adoptingpositive behavioursBy working with the various participant groups from affectedcommunities you can discover individual views of the benefits ofsafer hygiene practices This insight can provide the basis for amotivational strategy
4 Keep hygiene messages positivePeople learn best when they laugh and pay attention longer if theyare entertained Programmes that attempt to frighten the audienceswill tend to alienate them Therefore avoid the mention of death inhygiene promotion programmes
A special word on female hygieneProvisions for female hygiene have often been neglected in hygienepromotion programmes Recent lessons from emergency responsesin South Asia clearly show that many girls and women find it difficultto practice female hygienic behaviours because of one or more ofthe following constraints Unavailability of underwear and sanitary napkins Inaccessibility to sanitary napkins andor the manner in which
sanitary napkins are distributed in the camps and affectedareas
Lack of clean water and soap for washing and laundering Lack of privacy to change and wash launder underwear and
menstrual rags (in the absence of disposable sanitary napkins) Inappropriate positioning of female latrines Social taboos attached to menstruation Lack of knowledge or sensitivity among camp managers and relief
workers to hygiene and sanitation-related needs and requests
These issues make a strong casefor the need of a gender-sensitiveemergency response team in thecampsaffected areas These alsocall for sensitivity training for malecamp managers governmentofficials and health workers toensure that the needs of womenand girls are provided for
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 61
In the 1998 Bangladesh floods adolescent girls reported perineal rashes and urinary
tract infections because they could not properly wash themselves and launder and dry
menstrual rags in private They also lacked access to clean water The girls said they
wore the still damp clothes because they did not have a place to dry them
Women and girls of reproductive age must have access to appropriate materials for
absorption and disposal of menstrual blood Hygiene promoters should advocate for
providing private facilities for girls and women to wash themselves wash and dry
underwear and sanitary clothes and properly dispose of womenrsquos sanitary napkins7
A case in point
DOING THE GROUNDWORK
Doing the groundwork for your hygiene emergency response depends on
how well you were prepared in the first place what data and capacities
exist and which partnerships and networks you work with - whom you can
quickly tap When you do your ground work (rapid communication
assessment) keep in mind to build on what people already know rather
than importing ideas from people the community regards as ldquooutsidersrdquo
This should be the basis for any hygiene promotion programme
The following diagram shows how your planning team should work togetherwith representatives of the affected community in the rapid communicationassessment which is also a formative research process Your aim is toanswer four main questions Which specific practices are placing the peopleshealth at risk What messages are most crucial What or who could (serveas effective channels) motivate them to adopt new practices Who should betargeted by the hygiene promotion initiative And how can we communicatewith these groups effectively
HYGIENE PRO
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62 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
RAPID COMMUNICATION ASSESSMENTFOR HYGIENE PROMOTION 8
Assessment stagesIn an emergency situation one ofthe first steps to doing thegroundwork is the rapidassessment There are differentstages involved in the doing theassessment These stages helpyou to plan monitor and adjustyour hygiene promotionprogramme according tobehavioural results and feedbackfrom affected community groupshealth and relief workers camp managers and other stakeholders
Stage I You can do an initial rapid assessment using tools such as exploratory ortransect walks and interviews with key informants from the camps or affected areasas the case may be in order to identify priority issues You need to do this in thefirst few days after a disaster working with the emergency rapid assessment team
Stage II Use the initial data from Stage I in group discussions with campmanagers and dwellers as appropriate with assessment tools such as mappingnetwork analysis focus group discussions and household observation This couldbe undertaken between weeks two and four after a disaster
Stage III Obtain a deeper understanding of what people know do and think byusing tools such as matrix ranking seasonal calendars three pile sorting pocketcharts and gender analysis (see below) also as appropriate and feasible You canchoose to do this after you have collected the initial data
Assessment toolsPlease refer to Part III of the toolkit for further participatory assessment andplanning tools You can also use the two simple examples below to help youunderstand the hygiene practices and beliefs of the affected community
Ranking exerciseIn a ranking exercise ask participants to rank their health needs and priorities on anumerical scale that you would have prepared earlier A facilitator then guides adiscussion with the participants on the relevance and appropriateness of theirchoices Ranking provides a quick way to assess the affected communityrsquoshygiene and sanitation practices and gets them involved in the initial stages of ahygiene promotion programme Please see Tool 7 in Part III of the toolkit
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
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64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
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BEHAVIOUR CHANGE COMMUNICATION
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The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
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68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
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70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
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72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
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HYGIENE PRO
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74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
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INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
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78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
56 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
WHY PROMOTE HYGIENE IN EMERGENCIES
PRINCIPLES OF HYGIENE PROMOTION
DOING THE GROUNDWORK
GETTING THE MESSAGE RIGHT
COMMUNICATION ACTIONS FOR HYGIENE PROMOTION
MONITORING MILESTONES
PRACTICAL EXPERIENCES
RESOURCE BANK
HYGIENE PROMOTIONC H A P T E R - 4
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 57
Hygiene is the practice
of keeping oneself and
ones surroundings
clean especially in
order to prevent illness
or the spread of
disease Emergencies
create an environment
in which germs flourish
over crowding
traumatised immune systems poor (or no) access to facilities
latrines safe water and exposure to disease pathogens - all of which
endanger peoples health and survival
WHY PROMOTE HYGIENEIN EMERGENCIES
Research shows that hygienic practicescan have an equal or greater impact ondisease prevention than water supply andsanitation facilities Modern thinkingsuggests that the two must go hand-in-hand to effectively combat disease and toboost healthy sustainable hygienicbehaviours
What is hygienepromotionHygiene promotion empowers people toprevent disease It is the process ofinfluencing peoplersquos knowledge attitudesand practices and an agencyrsquos knowledge
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PAKISTAN A mother washes her daughterrsquos hands with soap and water near theirtemporary shelter
Common myths in hygienepromotion that you can avoid1 People are empty vessels into
which new ideas can simply bepoured
2 People will listen to me because
Im medically trained3 People can learn germ theory in a
few sessions at the health centre
4 Health education can reach largepopulations
5 Knowing means doing
Source Curtis V5
HYGIENE PRO
MO
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58 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
F-DIAGRAM HOW DO PEOPLE CATCH DIARRHOEA 4and resources which together enable family members to avoid risky behavioursrelated to water use waste and excreta disposal and cleaning habits1
The key ingredients to effective hygiene promotion are A mutual sharing of information and knowledge Mobilising communities for concerted action Providing essential supplies and facilities
We can group hygiene promotion into three categories2
Reducing high-risk hygienic practices Promoting appropriate use and maintenance of facilities Promoting participation in programmes
Such a multi-pronged approach should enable the affected community to practicehygienic behaviours and stay healthy
The role of hygiene promotion in emergenciesPreventing diarrhoeal infection by promoting hygienic practices should be yourcommunication priority Number One in an emergency situation In camp situationsdiarrhoeal diseases can account from 25 to 40 percent of deaths in the acute phase of anemergency More than 80 percent of the deaths usually occur in children under 2 years
The F-diagram below illustrates the different routes diarrhoea microbes take from faecesto a person Interrupting the transmission chain thus should be your first priority
F-diagram How do people catch diarrhoea4
Faeces
Fingers
Flies
Food New host
Fields
Fluids
PB SB
SB
PB Primary barrierSB Secondary barrierAdapted from Kawata 1978
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 59
PRINCIPLES OFHYGIENE PROMOTIONIn emergency situations you have to
coordinate closely with all agencies
involved in relief work on a small
number of hygiene messages of
proven public health importance
Coordination of programme
communication activities avoids
duplication of efforts and wasting of time and resources - both of
the programmes and of the affected community Apply the following
essential principles to hygiene promotion
1 Focus on a small number of risk practicesTo control diarrhoeal disease your messages should highlight the priority hygienepractices hand wash with water and soap or when not available use ash aftercontact with faeces and safe disposal of adultsrsquo and childrenrsquos faeces to preventinfection and contamination ndash ie clear scattered faeces control open defaecationand shallow trench latrines repair toilet facilities andor build temporary family orcommunal latrines6
2 Involve specific participant groupsInvolve fathers mothers children older siblings opinion leaders and otherinfluential persons and groups in the affected community Public health promotersneed to identify primary child caregivers and those who influence and makedecisions for them Involve these influencers in the different stages of a healthpromotion initiative
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NEPAL Teaching proper hand washingtechniques in Pumdi Bhumdi 2004
HYGIENE PRO
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60 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
3 Identify the motives for adoptingpositive behavioursBy working with the various participant groups from affectedcommunities you can discover individual views of the benefits ofsafer hygiene practices This insight can provide the basis for amotivational strategy
4 Keep hygiene messages positivePeople learn best when they laugh and pay attention longer if theyare entertained Programmes that attempt to frighten the audienceswill tend to alienate them Therefore avoid the mention of death inhygiene promotion programmes
A special word on female hygieneProvisions for female hygiene have often been neglected in hygienepromotion programmes Recent lessons from emergency responsesin South Asia clearly show that many girls and women find it difficultto practice female hygienic behaviours because of one or more ofthe following constraints Unavailability of underwear and sanitary napkins Inaccessibility to sanitary napkins andor the manner in which
sanitary napkins are distributed in the camps and affectedareas
Lack of clean water and soap for washing and laundering Lack of privacy to change and wash launder underwear and
menstrual rags (in the absence of disposable sanitary napkins) Inappropriate positioning of female latrines Social taboos attached to menstruation Lack of knowledge or sensitivity among camp managers and relief
workers to hygiene and sanitation-related needs and requests
These issues make a strong casefor the need of a gender-sensitiveemergency response team in thecampsaffected areas These alsocall for sensitivity training for malecamp managers governmentofficials and health workers toensure that the needs of womenand girls are provided for
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 61
In the 1998 Bangladesh floods adolescent girls reported perineal rashes and urinary
tract infections because they could not properly wash themselves and launder and dry
menstrual rags in private They also lacked access to clean water The girls said they
wore the still damp clothes because they did not have a place to dry them
Women and girls of reproductive age must have access to appropriate materials for
absorption and disposal of menstrual blood Hygiene promoters should advocate for
providing private facilities for girls and women to wash themselves wash and dry
underwear and sanitary clothes and properly dispose of womenrsquos sanitary napkins7
A case in point
DOING THE GROUNDWORK
Doing the groundwork for your hygiene emergency response depends on
how well you were prepared in the first place what data and capacities
exist and which partnerships and networks you work with - whom you can
quickly tap When you do your ground work (rapid communication
assessment) keep in mind to build on what people already know rather
than importing ideas from people the community regards as ldquooutsidersrdquo
This should be the basis for any hygiene promotion programme
The following diagram shows how your planning team should work togetherwith representatives of the affected community in the rapid communicationassessment which is also a formative research process Your aim is toanswer four main questions Which specific practices are placing the peopleshealth at risk What messages are most crucial What or who could (serveas effective channels) motivate them to adopt new practices Who should betargeted by the hygiene promotion initiative And how can we communicatewith these groups effectively
HYGIENE PRO
MO
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62 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
RAPID COMMUNICATION ASSESSMENTFOR HYGIENE PROMOTION 8
Assessment stagesIn an emergency situation one ofthe first steps to doing thegroundwork is the rapidassessment There are differentstages involved in the doing theassessment These stages helpyou to plan monitor and adjustyour hygiene promotionprogramme according tobehavioural results and feedbackfrom affected community groupshealth and relief workers camp managers and other stakeholders
Stage I You can do an initial rapid assessment using tools such as exploratory ortransect walks and interviews with key informants from the camps or affected areasas the case may be in order to identify priority issues You need to do this in thefirst few days after a disaster working with the emergency rapid assessment team
Stage II Use the initial data from Stage I in group discussions with campmanagers and dwellers as appropriate with assessment tools such as mappingnetwork analysis focus group discussions and household observation This couldbe undertaken between weeks two and four after a disaster
Stage III Obtain a deeper understanding of what people know do and think byusing tools such as matrix ranking seasonal calendars three pile sorting pocketcharts and gender analysis (see below) also as appropriate and feasible You canchoose to do this after you have collected the initial data
Assessment toolsPlease refer to Part III of the toolkit for further participatory assessment andplanning tools You can also use the two simple examples below to help youunderstand the hygiene practices and beliefs of the affected community
Ranking exerciseIn a ranking exercise ask participants to rank their health needs and priorities on anumerical scale that you would have prepared earlier A facilitator then guides adiscussion with the participants on the relevance and appropriateness of theirchoices Ranking provides a quick way to assess the affected communityrsquoshygiene and sanitation practices and gets them involved in the initial stages of ahygiene promotion programme Please see Tool 7 in Part III of the toolkit
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
MO
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64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 65
The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
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68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
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70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
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72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
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HYGIENE PRO
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74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
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INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
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78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 57
Hygiene is the practice
of keeping oneself and
ones surroundings
clean especially in
order to prevent illness
or the spread of
disease Emergencies
create an environment
in which germs flourish
over crowding
traumatised immune systems poor (or no) access to facilities
latrines safe water and exposure to disease pathogens - all of which
endanger peoples health and survival
WHY PROMOTE HYGIENEIN EMERGENCIES
Research shows that hygienic practicescan have an equal or greater impact ondisease prevention than water supply andsanitation facilities Modern thinkingsuggests that the two must go hand-in-hand to effectively combat disease and toboost healthy sustainable hygienicbehaviours
What is hygienepromotionHygiene promotion empowers people toprevent disease It is the process ofinfluencing peoplersquos knowledge attitudesand practices and an agencyrsquos knowledge
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PAKISTAN A mother washes her daughterrsquos hands with soap and water near theirtemporary shelter
Common myths in hygienepromotion that you can avoid1 People are empty vessels into
which new ideas can simply bepoured
2 People will listen to me because
Im medically trained3 People can learn germ theory in a
few sessions at the health centre
4 Health education can reach largepopulations
5 Knowing means doing
Source Curtis V5
HYGIENE PRO
MO
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58 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
F-DIAGRAM HOW DO PEOPLE CATCH DIARRHOEA 4and resources which together enable family members to avoid risky behavioursrelated to water use waste and excreta disposal and cleaning habits1
The key ingredients to effective hygiene promotion are A mutual sharing of information and knowledge Mobilising communities for concerted action Providing essential supplies and facilities
We can group hygiene promotion into three categories2
Reducing high-risk hygienic practices Promoting appropriate use and maintenance of facilities Promoting participation in programmes
Such a multi-pronged approach should enable the affected community to practicehygienic behaviours and stay healthy
The role of hygiene promotion in emergenciesPreventing diarrhoeal infection by promoting hygienic practices should be yourcommunication priority Number One in an emergency situation In camp situationsdiarrhoeal diseases can account from 25 to 40 percent of deaths in the acute phase of anemergency More than 80 percent of the deaths usually occur in children under 2 years
The F-diagram below illustrates the different routes diarrhoea microbes take from faecesto a person Interrupting the transmission chain thus should be your first priority
F-diagram How do people catch diarrhoea4
Faeces
Fingers
Flies
Food New host
Fields
Fluids
PB SB
SB
PB Primary barrierSB Secondary barrierAdapted from Kawata 1978
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 59
PRINCIPLES OFHYGIENE PROMOTIONIn emergency situations you have to
coordinate closely with all agencies
involved in relief work on a small
number of hygiene messages of
proven public health importance
Coordination of programme
communication activities avoids
duplication of efforts and wasting of time and resources - both of
the programmes and of the affected community Apply the following
essential principles to hygiene promotion
1 Focus on a small number of risk practicesTo control diarrhoeal disease your messages should highlight the priority hygienepractices hand wash with water and soap or when not available use ash aftercontact with faeces and safe disposal of adultsrsquo and childrenrsquos faeces to preventinfection and contamination ndash ie clear scattered faeces control open defaecationand shallow trench latrines repair toilet facilities andor build temporary family orcommunal latrines6
2 Involve specific participant groupsInvolve fathers mothers children older siblings opinion leaders and otherinfluential persons and groups in the affected community Public health promotersneed to identify primary child caregivers and those who influence and makedecisions for them Involve these influencers in the different stages of a healthpromotion initiative
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NEPAL Teaching proper hand washingtechniques in Pumdi Bhumdi 2004
HYGIENE PRO
MO
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60 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
3 Identify the motives for adoptingpositive behavioursBy working with the various participant groups from affectedcommunities you can discover individual views of the benefits ofsafer hygiene practices This insight can provide the basis for amotivational strategy
4 Keep hygiene messages positivePeople learn best when they laugh and pay attention longer if theyare entertained Programmes that attempt to frighten the audienceswill tend to alienate them Therefore avoid the mention of death inhygiene promotion programmes
A special word on female hygieneProvisions for female hygiene have often been neglected in hygienepromotion programmes Recent lessons from emergency responsesin South Asia clearly show that many girls and women find it difficultto practice female hygienic behaviours because of one or more ofthe following constraints Unavailability of underwear and sanitary napkins Inaccessibility to sanitary napkins andor the manner in which
sanitary napkins are distributed in the camps and affectedareas
Lack of clean water and soap for washing and laundering Lack of privacy to change and wash launder underwear and
menstrual rags (in the absence of disposable sanitary napkins) Inappropriate positioning of female latrines Social taboos attached to menstruation Lack of knowledge or sensitivity among camp managers and relief
workers to hygiene and sanitation-related needs and requests
These issues make a strong casefor the need of a gender-sensitiveemergency response team in thecampsaffected areas These alsocall for sensitivity training for malecamp managers governmentofficials and health workers toensure that the needs of womenand girls are provided for
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 61
In the 1998 Bangladesh floods adolescent girls reported perineal rashes and urinary
tract infections because they could not properly wash themselves and launder and dry
menstrual rags in private They also lacked access to clean water The girls said they
wore the still damp clothes because they did not have a place to dry them
Women and girls of reproductive age must have access to appropriate materials for
absorption and disposal of menstrual blood Hygiene promoters should advocate for
providing private facilities for girls and women to wash themselves wash and dry
underwear and sanitary clothes and properly dispose of womenrsquos sanitary napkins7
A case in point
DOING THE GROUNDWORK
Doing the groundwork for your hygiene emergency response depends on
how well you were prepared in the first place what data and capacities
exist and which partnerships and networks you work with - whom you can
quickly tap When you do your ground work (rapid communication
assessment) keep in mind to build on what people already know rather
than importing ideas from people the community regards as ldquooutsidersrdquo
This should be the basis for any hygiene promotion programme
The following diagram shows how your planning team should work togetherwith representatives of the affected community in the rapid communicationassessment which is also a formative research process Your aim is toanswer four main questions Which specific practices are placing the peopleshealth at risk What messages are most crucial What or who could (serveas effective channels) motivate them to adopt new practices Who should betargeted by the hygiene promotion initiative And how can we communicatewith these groups effectively
HYGIENE PRO
MO
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62 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
RAPID COMMUNICATION ASSESSMENTFOR HYGIENE PROMOTION 8
Assessment stagesIn an emergency situation one ofthe first steps to doing thegroundwork is the rapidassessment There are differentstages involved in the doing theassessment These stages helpyou to plan monitor and adjustyour hygiene promotionprogramme according tobehavioural results and feedbackfrom affected community groupshealth and relief workers camp managers and other stakeholders
Stage I You can do an initial rapid assessment using tools such as exploratory ortransect walks and interviews with key informants from the camps or affected areasas the case may be in order to identify priority issues You need to do this in thefirst few days after a disaster working with the emergency rapid assessment team
Stage II Use the initial data from Stage I in group discussions with campmanagers and dwellers as appropriate with assessment tools such as mappingnetwork analysis focus group discussions and household observation This couldbe undertaken between weeks two and four after a disaster
Stage III Obtain a deeper understanding of what people know do and think byusing tools such as matrix ranking seasonal calendars three pile sorting pocketcharts and gender analysis (see below) also as appropriate and feasible You canchoose to do this after you have collected the initial data
Assessment toolsPlease refer to Part III of the toolkit for further participatory assessment andplanning tools You can also use the two simple examples below to help youunderstand the hygiene practices and beliefs of the affected community
Ranking exerciseIn a ranking exercise ask participants to rank their health needs and priorities on anumerical scale that you would have prepared earlier A facilitator then guides adiscussion with the participants on the relevance and appropriateness of theirchoices Ranking provides a quick way to assess the affected communityrsquoshygiene and sanitation practices and gets them involved in the initial stages of ahygiene promotion programme Please see Tool 7 in Part III of the toolkit
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
MO
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64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 65
The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
TION
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
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70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
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72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
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kistan
HYGIENE PRO
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74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
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INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
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78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
58 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
F-DIAGRAM HOW DO PEOPLE CATCH DIARRHOEA 4and resources which together enable family members to avoid risky behavioursrelated to water use waste and excreta disposal and cleaning habits1
The key ingredients to effective hygiene promotion are A mutual sharing of information and knowledge Mobilising communities for concerted action Providing essential supplies and facilities
We can group hygiene promotion into three categories2
Reducing high-risk hygienic practices Promoting appropriate use and maintenance of facilities Promoting participation in programmes
Such a multi-pronged approach should enable the affected community to practicehygienic behaviours and stay healthy
The role of hygiene promotion in emergenciesPreventing diarrhoeal infection by promoting hygienic practices should be yourcommunication priority Number One in an emergency situation In camp situationsdiarrhoeal diseases can account from 25 to 40 percent of deaths in the acute phase of anemergency More than 80 percent of the deaths usually occur in children under 2 years
The F-diagram below illustrates the different routes diarrhoea microbes take from faecesto a person Interrupting the transmission chain thus should be your first priority
F-diagram How do people catch diarrhoea4
Faeces
Fingers
Flies
Food New host
Fields
Fluids
PB SB
SB
PB Primary barrierSB Secondary barrierAdapted from Kawata 1978
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 59
PRINCIPLES OFHYGIENE PROMOTIONIn emergency situations you have to
coordinate closely with all agencies
involved in relief work on a small
number of hygiene messages of
proven public health importance
Coordination of programme
communication activities avoids
duplication of efforts and wasting of time and resources - both of
the programmes and of the affected community Apply the following
essential principles to hygiene promotion
1 Focus on a small number of risk practicesTo control diarrhoeal disease your messages should highlight the priority hygienepractices hand wash with water and soap or when not available use ash aftercontact with faeces and safe disposal of adultsrsquo and childrenrsquos faeces to preventinfection and contamination ndash ie clear scattered faeces control open defaecationand shallow trench latrines repair toilet facilities andor build temporary family orcommunal latrines6
2 Involve specific participant groupsInvolve fathers mothers children older siblings opinion leaders and otherinfluential persons and groups in the affected community Public health promotersneed to identify primary child caregivers and those who influence and makedecisions for them Involve these influencers in the different stages of a healthpromotion initiative
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NEPAL Teaching proper hand washingtechniques in Pumdi Bhumdi 2004
HYGIENE PRO
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60 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
3 Identify the motives for adoptingpositive behavioursBy working with the various participant groups from affectedcommunities you can discover individual views of the benefits ofsafer hygiene practices This insight can provide the basis for amotivational strategy
4 Keep hygiene messages positivePeople learn best when they laugh and pay attention longer if theyare entertained Programmes that attempt to frighten the audienceswill tend to alienate them Therefore avoid the mention of death inhygiene promotion programmes
A special word on female hygieneProvisions for female hygiene have often been neglected in hygienepromotion programmes Recent lessons from emergency responsesin South Asia clearly show that many girls and women find it difficultto practice female hygienic behaviours because of one or more ofthe following constraints Unavailability of underwear and sanitary napkins Inaccessibility to sanitary napkins andor the manner in which
sanitary napkins are distributed in the camps and affectedareas
Lack of clean water and soap for washing and laundering Lack of privacy to change and wash launder underwear and
menstrual rags (in the absence of disposable sanitary napkins) Inappropriate positioning of female latrines Social taboos attached to menstruation Lack of knowledge or sensitivity among camp managers and relief
workers to hygiene and sanitation-related needs and requests
These issues make a strong casefor the need of a gender-sensitiveemergency response team in thecampsaffected areas These alsocall for sensitivity training for malecamp managers governmentofficials and health workers toensure that the needs of womenand girls are provided for
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 61
In the 1998 Bangladesh floods adolescent girls reported perineal rashes and urinary
tract infections because they could not properly wash themselves and launder and dry
menstrual rags in private They also lacked access to clean water The girls said they
wore the still damp clothes because they did not have a place to dry them
Women and girls of reproductive age must have access to appropriate materials for
absorption and disposal of menstrual blood Hygiene promoters should advocate for
providing private facilities for girls and women to wash themselves wash and dry
underwear and sanitary clothes and properly dispose of womenrsquos sanitary napkins7
A case in point
DOING THE GROUNDWORK
Doing the groundwork for your hygiene emergency response depends on
how well you were prepared in the first place what data and capacities
exist and which partnerships and networks you work with - whom you can
quickly tap When you do your ground work (rapid communication
assessment) keep in mind to build on what people already know rather
than importing ideas from people the community regards as ldquooutsidersrdquo
This should be the basis for any hygiene promotion programme
The following diagram shows how your planning team should work togetherwith representatives of the affected community in the rapid communicationassessment which is also a formative research process Your aim is toanswer four main questions Which specific practices are placing the peopleshealth at risk What messages are most crucial What or who could (serveas effective channels) motivate them to adopt new practices Who should betargeted by the hygiene promotion initiative And how can we communicatewith these groups effectively
HYGIENE PRO
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62 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
RAPID COMMUNICATION ASSESSMENTFOR HYGIENE PROMOTION 8
Assessment stagesIn an emergency situation one ofthe first steps to doing thegroundwork is the rapidassessment There are differentstages involved in the doing theassessment These stages helpyou to plan monitor and adjustyour hygiene promotionprogramme according tobehavioural results and feedbackfrom affected community groupshealth and relief workers camp managers and other stakeholders
Stage I You can do an initial rapid assessment using tools such as exploratory ortransect walks and interviews with key informants from the camps or affected areasas the case may be in order to identify priority issues You need to do this in thefirst few days after a disaster working with the emergency rapid assessment team
Stage II Use the initial data from Stage I in group discussions with campmanagers and dwellers as appropriate with assessment tools such as mappingnetwork analysis focus group discussions and household observation This couldbe undertaken between weeks two and four after a disaster
Stage III Obtain a deeper understanding of what people know do and think byusing tools such as matrix ranking seasonal calendars three pile sorting pocketcharts and gender analysis (see below) also as appropriate and feasible You canchoose to do this after you have collected the initial data
Assessment toolsPlease refer to Part III of the toolkit for further participatory assessment andplanning tools You can also use the two simple examples below to help youunderstand the hygiene practices and beliefs of the affected community
Ranking exerciseIn a ranking exercise ask participants to rank their health needs and priorities on anumerical scale that you would have prepared earlier A facilitator then guides adiscussion with the participants on the relevance and appropriateness of theirchoices Ranking provides a quick way to assess the affected communityrsquoshygiene and sanitation practices and gets them involved in the initial stages of ahygiene promotion programme Please see Tool 7 in Part III of the toolkit
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
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64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
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BEHAVIOUR CHANGE COMMUNICATION
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The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
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68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
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70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
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72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
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HYGIENE PRO
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74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
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INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
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78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 59
PRINCIPLES OFHYGIENE PROMOTIONIn emergency situations you have to
coordinate closely with all agencies
involved in relief work on a small
number of hygiene messages of
proven public health importance
Coordination of programme
communication activities avoids
duplication of efforts and wasting of time and resources - both of
the programmes and of the affected community Apply the following
essential principles to hygiene promotion
1 Focus on a small number of risk practicesTo control diarrhoeal disease your messages should highlight the priority hygienepractices hand wash with water and soap or when not available use ash aftercontact with faeces and safe disposal of adultsrsquo and childrenrsquos faeces to preventinfection and contamination ndash ie clear scattered faeces control open defaecationand shallow trench latrines repair toilet facilities andor build temporary family orcommunal latrines6
2 Involve specific participant groupsInvolve fathers mothers children older siblings opinion leaders and otherinfluential persons and groups in the affected community Public health promotersneed to identify primary child caregivers and those who influence and makedecisions for them Involve these influencers in the different stages of a healthpromotion initiative
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NEPAL Teaching proper hand washingtechniques in Pumdi Bhumdi 2004
HYGIENE PRO
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60 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
3 Identify the motives for adoptingpositive behavioursBy working with the various participant groups from affectedcommunities you can discover individual views of the benefits ofsafer hygiene practices This insight can provide the basis for amotivational strategy
4 Keep hygiene messages positivePeople learn best when they laugh and pay attention longer if theyare entertained Programmes that attempt to frighten the audienceswill tend to alienate them Therefore avoid the mention of death inhygiene promotion programmes
A special word on female hygieneProvisions for female hygiene have often been neglected in hygienepromotion programmes Recent lessons from emergency responsesin South Asia clearly show that many girls and women find it difficultto practice female hygienic behaviours because of one or more ofthe following constraints Unavailability of underwear and sanitary napkins Inaccessibility to sanitary napkins andor the manner in which
sanitary napkins are distributed in the camps and affectedareas
Lack of clean water and soap for washing and laundering Lack of privacy to change and wash launder underwear and
menstrual rags (in the absence of disposable sanitary napkins) Inappropriate positioning of female latrines Social taboos attached to menstruation Lack of knowledge or sensitivity among camp managers and relief
workers to hygiene and sanitation-related needs and requests
These issues make a strong casefor the need of a gender-sensitiveemergency response team in thecampsaffected areas These alsocall for sensitivity training for malecamp managers governmentofficials and health workers toensure that the needs of womenand girls are provided for
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 61
In the 1998 Bangladesh floods adolescent girls reported perineal rashes and urinary
tract infections because they could not properly wash themselves and launder and dry
menstrual rags in private They also lacked access to clean water The girls said they
wore the still damp clothes because they did not have a place to dry them
Women and girls of reproductive age must have access to appropriate materials for
absorption and disposal of menstrual blood Hygiene promoters should advocate for
providing private facilities for girls and women to wash themselves wash and dry
underwear and sanitary clothes and properly dispose of womenrsquos sanitary napkins7
A case in point
DOING THE GROUNDWORK
Doing the groundwork for your hygiene emergency response depends on
how well you were prepared in the first place what data and capacities
exist and which partnerships and networks you work with - whom you can
quickly tap When you do your ground work (rapid communication
assessment) keep in mind to build on what people already know rather
than importing ideas from people the community regards as ldquooutsidersrdquo
This should be the basis for any hygiene promotion programme
The following diagram shows how your planning team should work togetherwith representatives of the affected community in the rapid communicationassessment which is also a formative research process Your aim is toanswer four main questions Which specific practices are placing the peopleshealth at risk What messages are most crucial What or who could (serveas effective channels) motivate them to adopt new practices Who should betargeted by the hygiene promotion initiative And how can we communicatewith these groups effectively
HYGIENE PRO
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62 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
RAPID COMMUNICATION ASSESSMENTFOR HYGIENE PROMOTION 8
Assessment stagesIn an emergency situation one ofthe first steps to doing thegroundwork is the rapidassessment There are differentstages involved in the doing theassessment These stages helpyou to plan monitor and adjustyour hygiene promotionprogramme according tobehavioural results and feedbackfrom affected community groupshealth and relief workers camp managers and other stakeholders
Stage I You can do an initial rapid assessment using tools such as exploratory ortransect walks and interviews with key informants from the camps or affected areasas the case may be in order to identify priority issues You need to do this in thefirst few days after a disaster working with the emergency rapid assessment team
Stage II Use the initial data from Stage I in group discussions with campmanagers and dwellers as appropriate with assessment tools such as mappingnetwork analysis focus group discussions and household observation This couldbe undertaken between weeks two and four after a disaster
Stage III Obtain a deeper understanding of what people know do and think byusing tools such as matrix ranking seasonal calendars three pile sorting pocketcharts and gender analysis (see below) also as appropriate and feasible You canchoose to do this after you have collected the initial data
Assessment toolsPlease refer to Part III of the toolkit for further participatory assessment andplanning tools You can also use the two simple examples below to help youunderstand the hygiene practices and beliefs of the affected community
Ranking exerciseIn a ranking exercise ask participants to rank their health needs and priorities on anumerical scale that you would have prepared earlier A facilitator then guides adiscussion with the participants on the relevance and appropriateness of theirchoices Ranking provides a quick way to assess the affected communityrsquoshygiene and sanitation practices and gets them involved in the initial stages of ahygiene promotion programme Please see Tool 7 in Part III of the toolkit
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
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64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
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BEHAVIOUR CHANGE COMMUNICATION
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The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
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BEHAVIOUR CHANGE COMMUNICATION
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TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
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68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
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70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
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72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
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HYGIENE PRO
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74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
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INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
60 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
3 Identify the motives for adoptingpositive behavioursBy working with the various participant groups from affectedcommunities you can discover individual views of the benefits ofsafer hygiene practices This insight can provide the basis for amotivational strategy
4 Keep hygiene messages positivePeople learn best when they laugh and pay attention longer if theyare entertained Programmes that attempt to frighten the audienceswill tend to alienate them Therefore avoid the mention of death inhygiene promotion programmes
A special word on female hygieneProvisions for female hygiene have often been neglected in hygienepromotion programmes Recent lessons from emergency responsesin South Asia clearly show that many girls and women find it difficultto practice female hygienic behaviours because of one or more ofthe following constraints Unavailability of underwear and sanitary napkins Inaccessibility to sanitary napkins andor the manner in which
sanitary napkins are distributed in the camps and affectedareas
Lack of clean water and soap for washing and laundering Lack of privacy to change and wash launder underwear and
menstrual rags (in the absence of disposable sanitary napkins) Inappropriate positioning of female latrines Social taboos attached to menstruation Lack of knowledge or sensitivity among camp managers and relief
workers to hygiene and sanitation-related needs and requests
These issues make a strong casefor the need of a gender-sensitiveemergency response team in thecampsaffected areas These alsocall for sensitivity training for malecamp managers governmentofficials and health workers toensure that the needs of womenand girls are provided for
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 61
In the 1998 Bangladesh floods adolescent girls reported perineal rashes and urinary
tract infections because they could not properly wash themselves and launder and dry
menstrual rags in private They also lacked access to clean water The girls said they
wore the still damp clothes because they did not have a place to dry them
Women and girls of reproductive age must have access to appropriate materials for
absorption and disposal of menstrual blood Hygiene promoters should advocate for
providing private facilities for girls and women to wash themselves wash and dry
underwear and sanitary clothes and properly dispose of womenrsquos sanitary napkins7
A case in point
DOING THE GROUNDWORK
Doing the groundwork for your hygiene emergency response depends on
how well you were prepared in the first place what data and capacities
exist and which partnerships and networks you work with - whom you can
quickly tap When you do your ground work (rapid communication
assessment) keep in mind to build on what people already know rather
than importing ideas from people the community regards as ldquooutsidersrdquo
This should be the basis for any hygiene promotion programme
The following diagram shows how your planning team should work togetherwith representatives of the affected community in the rapid communicationassessment which is also a formative research process Your aim is toanswer four main questions Which specific practices are placing the peopleshealth at risk What messages are most crucial What or who could (serveas effective channels) motivate them to adopt new practices Who should betargeted by the hygiene promotion initiative And how can we communicatewith these groups effectively
HYGIENE PRO
MO
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62 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
RAPID COMMUNICATION ASSESSMENTFOR HYGIENE PROMOTION 8
Assessment stagesIn an emergency situation one ofthe first steps to doing thegroundwork is the rapidassessment There are differentstages involved in the doing theassessment These stages helpyou to plan monitor and adjustyour hygiene promotionprogramme according tobehavioural results and feedbackfrom affected community groupshealth and relief workers camp managers and other stakeholders
Stage I You can do an initial rapid assessment using tools such as exploratory ortransect walks and interviews with key informants from the camps or affected areasas the case may be in order to identify priority issues You need to do this in thefirst few days after a disaster working with the emergency rapid assessment team
Stage II Use the initial data from Stage I in group discussions with campmanagers and dwellers as appropriate with assessment tools such as mappingnetwork analysis focus group discussions and household observation This couldbe undertaken between weeks two and four after a disaster
Stage III Obtain a deeper understanding of what people know do and think byusing tools such as matrix ranking seasonal calendars three pile sorting pocketcharts and gender analysis (see below) also as appropriate and feasible You canchoose to do this after you have collected the initial data
Assessment toolsPlease refer to Part III of the toolkit for further participatory assessment andplanning tools You can also use the two simple examples below to help youunderstand the hygiene practices and beliefs of the affected community
Ranking exerciseIn a ranking exercise ask participants to rank their health needs and priorities on anumerical scale that you would have prepared earlier A facilitator then guides adiscussion with the participants on the relevance and appropriateness of theirchoices Ranking provides a quick way to assess the affected communityrsquoshygiene and sanitation practices and gets them involved in the initial stages of ahygiene promotion programme Please see Tool 7 in Part III of the toolkit
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
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64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 65
The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
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68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
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HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
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05
-00
04
Pa
llava
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gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 61
In the 1998 Bangladesh floods adolescent girls reported perineal rashes and urinary
tract infections because they could not properly wash themselves and launder and dry
menstrual rags in private They also lacked access to clean water The girls said they
wore the still damp clothes because they did not have a place to dry them
Women and girls of reproductive age must have access to appropriate materials for
absorption and disposal of menstrual blood Hygiene promoters should advocate for
providing private facilities for girls and women to wash themselves wash and dry
underwear and sanitary clothes and properly dispose of womenrsquos sanitary napkins7
A case in point
DOING THE GROUNDWORK
Doing the groundwork for your hygiene emergency response depends on
how well you were prepared in the first place what data and capacities
exist and which partnerships and networks you work with - whom you can
quickly tap When you do your ground work (rapid communication
assessment) keep in mind to build on what people already know rather
than importing ideas from people the community regards as ldquooutsidersrdquo
This should be the basis for any hygiene promotion programme
The following diagram shows how your planning team should work togetherwith representatives of the affected community in the rapid communicationassessment which is also a formative research process Your aim is toanswer four main questions Which specific practices are placing the peopleshealth at risk What messages are most crucial What or who could (serveas effective channels) motivate them to adopt new practices Who should betargeted by the hygiene promotion initiative And how can we communicatewith these groups effectively
HYGIENE PRO
MO
TION
62 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
RAPID COMMUNICATION ASSESSMENTFOR HYGIENE PROMOTION 8
Assessment stagesIn an emergency situation one ofthe first steps to doing thegroundwork is the rapidassessment There are differentstages involved in the doing theassessment These stages helpyou to plan monitor and adjustyour hygiene promotionprogramme according tobehavioural results and feedbackfrom affected community groupshealth and relief workers camp managers and other stakeholders
Stage I You can do an initial rapid assessment using tools such as exploratory ortransect walks and interviews with key informants from the camps or affected areasas the case may be in order to identify priority issues You need to do this in thefirst few days after a disaster working with the emergency rapid assessment team
Stage II Use the initial data from Stage I in group discussions with campmanagers and dwellers as appropriate with assessment tools such as mappingnetwork analysis focus group discussions and household observation This couldbe undertaken between weeks two and four after a disaster
Stage III Obtain a deeper understanding of what people know do and think byusing tools such as matrix ranking seasonal calendars three pile sorting pocketcharts and gender analysis (see below) also as appropriate and feasible You canchoose to do this after you have collected the initial data
Assessment toolsPlease refer to Part III of the toolkit for further participatory assessment andplanning tools You can also use the two simple examples below to help youunderstand the hygiene practices and beliefs of the affected community
Ranking exerciseIn a ranking exercise ask participants to rank their health needs and priorities on anumerical scale that you would have prepared earlier A facilitator then guides adiscussion with the participants on the relevance and appropriateness of theirchoices Ranking provides a quick way to assess the affected communityrsquoshygiene and sanitation practices and gets them involved in the initial stages of ahygiene promotion programme Please see Tool 7 in Part III of the toolkit
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
MO
TION
64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
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pa
l
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 65
The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
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kist
an
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
TION
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
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Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
62 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
RAPID COMMUNICATION ASSESSMENTFOR HYGIENE PROMOTION 8
Assessment stagesIn an emergency situation one ofthe first steps to doing thegroundwork is the rapidassessment There are differentstages involved in the doing theassessment These stages helpyou to plan monitor and adjustyour hygiene promotionprogramme according tobehavioural results and feedbackfrom affected community groupshealth and relief workers camp managers and other stakeholders
Stage I You can do an initial rapid assessment using tools such as exploratory ortransect walks and interviews with key informants from the camps or affected areasas the case may be in order to identify priority issues You need to do this in thefirst few days after a disaster working with the emergency rapid assessment team
Stage II Use the initial data from Stage I in group discussions with campmanagers and dwellers as appropriate with assessment tools such as mappingnetwork analysis focus group discussions and household observation This couldbe undertaken between weeks two and four after a disaster
Stage III Obtain a deeper understanding of what people know do and think byusing tools such as matrix ranking seasonal calendars three pile sorting pocketcharts and gender analysis (see below) also as appropriate and feasible You canchoose to do this after you have collected the initial data
Assessment toolsPlease refer to Part III of the toolkit for further participatory assessment andplanning tools You can also use the two simple examples below to help youunderstand the hygiene practices and beliefs of the affected community
Ranking exerciseIn a ranking exercise ask participants to rank their health needs and priorities on anumerical scale that you would have prepared earlier A facilitator then guides adiscussion with the participants on the relevance and appropriateness of theirchoices Ranking provides a quick way to assess the affected communityrsquoshygiene and sanitation practices and gets them involved in the initial stages of ahygiene promotion programme Please see Tool 7 in Part III of the toolkit
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
MO
TION
64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
copy U
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pa
l
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 65
The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
copy U
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
TION
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
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HYGIENE PRO
MO
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74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
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HQ
05
-00
04
Pa
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Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 63
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PAKISTANWomen andchildren whowere displacedby the SouthAsia earthquakein October 2005fetch water froma water tankprovided byUNICEF
Focus group discussionsYou can do focus group discussions (FGDs) in an emergency situation evenamong a few participants say three to five FGDs help you determine whatmotivates people in the affected community to adopt safe practices and barriers fordoing so It is more productive to group the older women young womenadolescent girls men etc separately By so doing you can elicit uninhibitedresponses The qualities of the facilitator and the democratic manner in which thediscussions are conducted are critical to your effectiveness in eliciting reliableinformation Consider that most hygiene-related information is personal in SouthAsian cultures and affected groups may share this information only with trustedandor respected persons among peer groups or in private
Note on focus groupsYou can make arrangements for an FGD at any stage of an initiative You can alsouse it to share new information with affected community members while learningabout their practices and beliefs Please See Tool 8 in Part III of the toolkit
Developing behavioural objectivesOnce you have completed the initial rapid assessments you can then developSMART behavioural objectives for your hygiene promotion programme Thebehavioural objectives depend on many factors including the severity of anemergency pre-existing knowledge and practices access to and availability ofwater and sanitation facilities Please see Tool 1 in Part III of the toolkit
HYGIENE PRO
MO
TION
64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
copy U
NIC
EF
Ne
pa
l
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 65
The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
copy U
NIC
EF
Pa
kist
an
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
TION
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
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kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
64 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
While there are many factors thatcan help prevent diarrhoeal infectionevidence suggests that the two mainfactors are1 Hand washing with soap or ash
after contact with faeces2 Safe disposal of adults and
childrens excreta
These are the two most importantpractices that you need to promoteto prevent diarrhoeal infection in theinitial emergency response
GETTING THE MESSAGE RIGHTBe mindful that in emergencies having
too many messages can create
confusion The only way to make a
sensible choice is to know the main risk
factor for disease and death - diarrhoeal
infection - and to know what practices are
common among the affected families and
communities Messages also need to
reach the emergency and camp
managers and health workers to ensure
that the required supplies facilities and
services are available to the affected
community groups
Use at least 05 litres (8 ounces) ofwater and soap or ash and rub yourhands in at least three differentdirections
Note Use locally understoodmeasursements
Source The sustainability of hygiene behaviour and theeffectiveness of change interventions9
What is the correctway to wash hands
NEPAL A young girl fetches water from deep well
copy U
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Ne
pa
l
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 65
The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
copy U
NIC
EF
Pa
kist
an
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
TION
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 65
The key-hygiene related messagesfor all family members includingchildren are Wash your hands thoroughly
with water and soap or if soapis not available water and ashafter contact with faeces andbefore touching food or beforefeeding children
Dispose of all faeces safelyThe best way is to use a toiletor (pit or trench) latrine or otherappropriately safe alternatives
When diarrhoeal infection is not themost important risk factoranymore address the range ofother risk factors through goodhygiene practices like drinking safewater clean food preparations andsafe disposal of household refuse
Key messages can include
Keeping water clean and safe Use only water that comes from a safe source or is purified Boil water until the bubbles appear Drink only safe water Use clean containers with lidcap to store water Use a clean cup for drawing water from the container making sure your hands
are clean too
Handling food safely Wash hands with soap or ash before preparing food Always cover cooked food Keep kitchen and cooking utensils and water containers clean Keep rubbish bin away from food and cooking
Safe household refuse disposal Put rubbish in bin with lid Empty your rubbish in a collective pit When full cover rubbish in collective pit with soil
Building a local lexicon
Discovering local names for diseaseshelps the affected community linkillnesses with causes preventions andcures and it allows programmers to tailorthe messages
In Zaire people use 6 names to describeillnesses that are accompanied withloose stools A survey found that morethan 50 percent of the respondents usedORS to treat kuhara but less than one-sixth of the respondents used ORS totreat lukungga and kilonde ntumbo - alldiseases with diarrhoea symptomsProgrammers adjusted the messages topromote ORS use for each of the sixdiseases separately rather than using ageneral term such as diarrhoea
Source Strategic Communication forDevelopment Projects10 HYG
IENE PROM
OTIO
N
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
copy U
NIC
EF
Pa
kist
an
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
TION
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
66 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
If you have a problem with your rubbish contact1 Camp management2 Municipal council3 Urban council
Developing and choosing the right and appropriate local variations of these basicmessages depends on (1) your knowledge of the main risk factors for disease anddeath in the emergency situation and (2) your knowledge of which practices arecommon among the affected families and communities
COMMUNICATIONACTIONS FORHYGIENEPROMOTIONUNICEFrsquos response to emergenciesis guided by the Core Commitmentsfor Children in Emergencies (CCC)which provide the overarchingorganisational framework in ahumanitarian response (see Chapter3) The table below outlinesUNICEFrsquos Core Commitments forChildren in Emergencies in theareas of Water Sanitation and
Hygiene We included suggested BCC and social mobilisation activities that haveshown evidence to improve hygiene situations in an emergency Remember to planyour risk communication and social mobilisation actions with the participation of theaffected community the children youth and your partners and to carefully monitorand evaluate the programme
When you choose the mix of communication actions remember that a key aspect tohygiene promotion is to target a small number of risk practices only For this reasonit is important for you to plan the activities in stages rather than trying to tackle allrisky behaviours at once11 Your mix of hygiene promotion actions depends on theimpact of the disaster identified priorities cultural and socio-economic contexts ofthe affected community availability of facilities and existing partnerships andcapacity ndash both human and financial
PAKISTAN Children wait for their turn to use the latrine in one of thecamps for people displaced by the South Asia earthquake
copy U
NIC
EF
Pa
kist
an
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
TION
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 67
TABLE UNICEFrsquos CCC in the areas of Water Sanitation andHygiene and corresponding BCC and social mobilisation support
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
1 Ensuring theavailability of aminimum safedrinking watersupply taking intoaccount the privacydignity and securityof women and girls
2 Providing bleachchlorine or waterpurification tabletsincluding detaileduser and safetyinstructions in thelocal language
3 Providing jerrycansor an appropriatealternative includinguser instructions andmessages in thelocal language onhandling of water anddisposal of excretaand solid waste
Make sure that those who are providing watersupplies are in dialogue with women and girlrepresentatives to determine the best modestimes locations andor distribution points forwater supplies
Make sure the affected community and serviceproviders receive information on the importanceof and how to use bleach chlorine or waterpurification tablets ndash ie through loudspeakerannouncements printed materials and IPC
Train motivated and interested people who livein or near the camp to provide groupdemonstrations on how to use bleach chlorineand water purification tablets
Enable service providers throughcommunication skills and counselling trainingto communicate with and motivate affectedindividuals and families to use bleach purifywater with chlorine or water purification tablets
Mobilise and engage community volunteers tomonitor changes
Assess the level of knowledge on hygieneaspects in the different populations of theaffected community (since it can vary widely)remembering that this is an area where mostrelated activities are carried out by women andgirls
HYGIENE PRO
MO
TION
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
68 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
Ensure affected community receives informationon importance of and how to handle safe waterdispose of excreta and solid waste ndash ie usinga combination of loudspeakers IEC materialscommunity radio andor peer educators
Enable hygiene promoters facilitators peereducators animators to provide one-to-one orsmall group participatory hygiene educationEnsure they can handle questions and clarifydoubts
Enable service providers to communicate withand motivate affected individuals and families towash hands handle safe water and dispose ofexcreta and solid waste
Engage motivated school-aged children or otherinterested groups to observe and shareinformation on the handling of safe waterdisposable of excreta and solid waste
Establish and train a team that is familiar withlocal practices and social structures
Use local languages or pictograms if possible Work through existing social structures to
ensure affected communities receive soap andinformation on benefits of hand washingcholera prevention and the prevention of otherexcreta-related diseases
Ensure that affected communities especiallyprimary caregivers know how to wash handswith soap and how to prepare ORS to preventdehydration by giving demonstrations on handwashing and how to make ORSORT
Train female communication agents includingcommunity health workers volunteers and GirlGuides to ensure womenrsquos and girlsrsquo access tobasic health and hygiene information
4 Providing soap anddisseminating keyhygiene messageson the dangers ofcholera and otherwater- and excreta-related diseases
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 69
TABLE UNICEFrsquos CCC in the areas of Water Sanitation and Hygieneand corresponding BCC and social mobilisation support Contd
SUPPORTIVE BCC ANDSOCIAL MOBILISATION ACTIONS
FIRST SIX TO EIGHTWEEKS
5 Facilitating the safedisposal of excretaand solid waste byproviding shovels orfunds for contractinglocal servicecompaniesspreading messageson the importance ofkeeping excreta(including infantfaeces) buried andaway fromhabitations andpublic areasdisseminatingmessages ondisposal of humanand animal corpsesand givinginstructions on andsupport forconstruction oftrench and pitlatrines
Train motivated school-aged children or othergroups to demonstrate proper hand washingtechniques and for them to observe communitypractices as part of monitoring
Make certain that affected community receivesinformation on importance of and how to keephuman (including infant) faeces from public andliving areas the importance of using latrines ndashie using IEC materials (including flip charts)demonstrations on how to dispose of infantfaecesdiapers
Engage positive deviants or people who buryinfant faeces and dispose solid waste properlyas positive role models
Enable service providers to communicate withand motivate affected individuals and families tosafely dispose of excreta and solid wastesafely dispose of human and animal corpsesand the use of trenchpit latrines
Train motivated young people to be ldquolinkleadersrdquo between camp residents andgovernment officials ndash ie to report on brokenand unsanitary facilities observe facilitymaintenance and use and help with monitoring
HYGIENE PRO
MO
TION
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
70 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
In the initial response of an emergency many activities are likely to beled by programme staff relief workers and government officials with theassistance of a rapidly mobilised task team of community volunteers Itis essential that you only implement the basic immediate actions thisway Be sure to plan implement and monitor all long-term aspects ofthe programme in partnership with affected community groups and otherrelevant stakeholders12
1 Making approachesand technologiesused consistent withnational standardsthus reinforcing long-term sustainability
2 Defining UNICEFrsquoscontinuinginvolvement beyondthe initial responseby
Establishingimproving andexpanding safewater systems forsourcedevelopmentdistributionpurification storageand drainagetaking into accountevolving needschanging healthrisks and greaterdemand
Make sure the affected community has theknowledge of how excreta contaminates waterand contributes to the spread of diarrhoealdisease and the relation between unsafe waterand cholera ndash ie through group discussionschildren volunteers loudspeakers communityradio community theatre and IEC materials
Mobilise the community to keep water safe ndash ietrain camp residents as water source attendantswho encourage people not to defecate near watersources train support workers to chlorinate allwells and test for residual chlorine levels13
Train health workers and other service providers onspecific cholera diarrhoea prevention methodsEnable them to motivate affected community tohandle safe water purify water through boilingchlorination or water purification tablets
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 71
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Providing a safewater supply andsanitation and handwashing facilities atschools and healthposts
Supplying andupgrading sanitationfacilities to includesemi-permanentstructures andhouseholdsolutions andproviding basicfamily sanitationkits
Strengthen community knowledge of handlingsafe water and importance of and how to washhands with soap using latrines ndash ie through IPClike animators IEC materials etc
Train educators health workers school-agechildren and campcommunity residents todemonstrate proper hand washing techniques
Empower service providers with tools andinformation to motivate school-age children andcommunity to use latrines and to wash handswith soap or ash after defecation
Observe pump and latrine maintenance andpromote hand washing practices at schools andhealth posts as part of monitoring
Involve the community in the designimplementation and maintenance of sanitationfacilities so that the facilities are culturallyappropriate private child-friendly accessible bythe disabled ndash and in line with the SphereStandards which can be reviewed at httpwwwsphereprojectorg
Enable service providers to motivate the affectedcommunity to use sanitation facilities and basicfamily sanitation kits
Specifically enable female service providers orcommunity health volunteers to communicatewith girls and women about female hygiene
Ensure that girls and women have access toappropriate materials for absorption and disposalof menstrual blood that facilities allow thedisposal of womenrsquos sanitary napkins or providethe necessary privacy for washing themselvesand for drying sanitary clothes
HYGIENE PRO
MO
TION
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
72 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
SUPPORTIVE BCC AND SOCIALMOBILISATION ACTIONS
BEYOND INITIALRESPONSE
Establishing regularhygiene promotionactivities
Planning for long-term solid wastedisposal
Train motivated school-age children andinterested groups to attend and monitor latrines ndashie report on broken or unsanitary latrines andwater pumps observe facilitylatrine use formonitoring purposes and put up motivational IECmaterials with hygiene messages eg posters
Identify main risk practices to adjust yourhygiene promotion initiative in affected areas
Ensure that affected individuals and communitiesunderstand good hygiene practices ndash ie byusing a mix channels like street plays traditionalfolk media video showings and other appropriateart forms that draw out local talents
Provide supportive supervision to ensure thathygiene promoters are discussing ways toprevent diarrhoea cholera and other excreta-related diseases with affected communities ndash ieby advocating hand washing with soap or ashand the use of latrines and by organising trainingsessions for community and opinion leaders onways to reduce risk of diarrhoea malaria orcholera casesoutbreaks 14
Mobilise community to monitor any changes ndashie hold community meetings to discuss andshare monitoring findings Jointly decide on howthe initiative can be improved
Facilitate water-related discussions on makingsafe water available Clearly identify therelationship between safe water waste disposaland disease and relate those factors to action ndashboth in the preparedness and emergencyphases
Engage affected communities in planning safeways to dispose of solid waste ndash ie by involvingthem in identifying solutions and developingmonitoring plans
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 73
MONITORING MILESTONES
One of the main aims of a hygiene promotion initiative in an
emergency situation is to ensure that all populations of the affected
community know and adopt the priority hygiene practices to protect
their health The following section presents the key indicators to
measure hygiene practices related to excreta disposal15 Tool 13 in
Part III lists possible sources of information to help you
measure the indicators
Key indicators for good hygiene practice People use the toilets available and childrenrsquos faeces are disposed of
immediately and hygienically People use toilets in the most hygienic way both for their own health and for the
health of others Household toilets are cleaned and maintained in such a way that they are used
by all intended users and are hygienic and safe to use Parents (mothers and fathers or other primary caregivers) demonstrate
knowledge of the need to dispose of childrenrsquosfaeces safely Families and individuals participate in a family
latrine programme by registering with the agency digging pits or collecting materials People wash their hands after defecation and
handling childrenrsquos faeces and before cooking and eating People demonstrate correct hand washing and
know when to engage in this behaviour
Key indicators for the designand implementation of yourhygiene promotion programmeIdeally you should base your hygiene promotionactivities on the specific vulnerabilities needs andpreferences of all populations in the affected
PAKISTAN A woman cleans a latrine in one ofthe temporary camps for people who weredisplaced by the South Asia earthquake
copy U
NIC
EF
Pa
kistan
HYGIENE PRO
MO
TION
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
74 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
communities These are often influenced by factors like displacement agegender ethnicity disability and socio-economic status Take note of the followingkey indicators for measuring the design and implementation of your hygienepromotion programme16
Key hygiene risks of public health importance are identified Programmes include an effective mechanism for representative and participa-
tory input from all users at all phases including the initial design and location offacilities ndash making sure that latrines accommodate the disabled are well-lit anddesigned to protect women from sexual molestation and provide girls andwomen the privacy to cleanse themselves wash underclothes and sanitaryrags
All groups within the affected community have equitable access to theresources or facilities needed to practice or continue the proper hygienepractices
Hygiene promotion messages and activities address key behaviours andmisconceptions and reach all participant groups Representatives from thesegroups participate in planning training implementation monitoring andevaluation
Participants take responsibility for the management and maintenance offacilities as appropriate and all populations of the affected communitycontribute equitably
Note Plan the behavioural monitoring and set indicators from the start andencourage follow-up action In other words encourage your staff partners andaffected communities to do something with the results of monitoring In planningthe monitoring and evaluation indicators you need to be concerned aboutinformation for action rather than ldquoinformation to be more informedrdquo17
PAKISTANAdolescent girlscooking outsidetheir family tent inone of the campsfor earthquakeaffected families
copy U
NIC
EF
Pa
kistan
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 75
PRACTICAL EXPERIENCES
College students trained to promote hygiene in tsunami relief camps IndiaAs UNICEF worked to provide and install water storage tanks in Nagapattinam andother tsunami-affected districts in India one of the priority goals was to prevent anoutbreak of diarrhoea With thousands of homeless huddling in 200-odd camps thethreats from diarrhoea dysentery and dehydration loomed
Just one week after the tsunami hit UNICEF in partnership with a social marketingagency trained 140 college students and cadets to deliver ORS demonstrations A teamconsisted of three student animators supervisors and UNICEF staff They travelled byvan from camp to camp to the worst-hit areas
One such team stopped at the Shakuntaladevi Ramaswami Kalyana Mandapam ndash areception hall for marriages cum temporary home ndash to some 300 people Theanimators supervised by UNICEFrsquos Geeta Athreya talked about how diarrhoea breaksout in crowded unsanitary conditions the importance of washing hands with soap andwater after defaecation before handling food and feeding children They organised handwashing demonstrations trained community volunteers to show others how to preventdiarrhoea and recognise the symptoms of dehydration They instructed the affectedindividuals on how to prepare ORS
This experience shows that even in the initial response group communication approachescan be used to influence participants to adopt healthy practices In this case livedemonstrations occurred simultaneously with flyer and pamphlet distribution Postersdisplaying messages about diarrhoea prevention and ORS were also tacked in public areasBy engaging a mix of communication channels the hygiene promotion team was able toincrease the possibilities of hygiene messages being heard remembered and applied
copy U
NIC
EF
HQ
05
-00
04
Pa
llava
Ba
gla
INDIA (Second from left) UNICEFProgramme Officer Geeta Athreyabriefs a team of UNICEF animatorsbefore they visit relief centres fortsunami-affected displaced peoplein the Union Territory ofPondicherry The teams arepromoting the use of ORS and goodhygiene practices to prevent andtreat diarrhoea and other water-related diseases Team membersare wearing T-shirts bearing theUNICEF logo
HYGIENE PRO
MO
TION
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT75
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
76 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
1 Almedom AM Blumenthal U and Manderson L Hygiene EvaluationProcedures Approaches and methods for assessing water and sanitation-related hygiene practices Herndon IT PublicationsStylus PublishingLondon 1996
2 Aubel J lsquoParticipatory Monitoring and Evaluation for Hygiene Improvement -Beyond the Toolbox What else is required for effective PMampErsquoEnvironmental Health Project Strategic Report No 9 Washington DC2004
3 Curtis V Cairncross S and Yonli R lsquoDomestic Hygiene and DiarrhoeaPinpointing the problemrsquo Tropical Medicine and International Health 5(1)pp 22-32
4 Department for International Development Guidance Manual on WaterSupply and Sanitation Programmes DFID London 1999
5 Ferron S et al Hygiene Promotion A practical manual for relief anddevelopment Intermediate Technology Publications London on behalf ofCARE International 2000
6 Huttly S et al lsquoPrevention of Diarrhoea in Young Children in DevelopingCountriesrsquo Bulletin of the World Health Organization 75(2) WHO Geneva2000 pp163-174
7 Narayan-Parker D lsquoParticipatory Evaluation Tools for managing change inwater and sanitationrsquo World Bank Technical Paper 207 The World BankWashington DC 1993
8 Sawyer R et al PHAST Step-by-Step Guide A participatory approach forthe control of diarrhoeal disease WHO Geneva 1998
9 Shordt K Action Monitoring for Effectiveness Improving water hygieneand environmental sanitation programmes IRC Delft 2000
10 Srinivasan L Tools for Community Participation A manual for trainingtrainers in participatory techniques PROWESSUNDP- World Bank Waterand Sanitation Program Washington DC 1993
11 Sukkary-Stolba S lsquoOral Rehydration Therapy The behavioural issuesrsquoBehavioural Issues in Child Survival Programs Monograph Number OneInternational Health and Development Associates Malibu 1990
12 United Nations Childrenrsquos Fund Happy Healthy and Hygienic How to setup a hygiene promotion programme UNICEF LSHTM 1998
13 United Nations Development Program - World Bank Water and SanitationProgram South Asia Region Improving User Participation to IncreaseProject Effectiveness Community action planning in an adaptive project -NWFP community infrastructure project 1998
RESOURCE BANK
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT 77
Web sites
1 Global Public-Private Partnership for Handwashing with Soaphttpwwwglobalhandwashingorg
2 Health Communication Partnershiphttpwwwhcpartnershiporgmmc
3 HealtheCommunicationhttpwwwcomminitcomhealthecommindexphp
4 HORIZON Communicationshttpwwwsolutions-siteorgartmanpublish
5 IRC International Water and Sanitation Centrehttpwwwircwatsannet
6 PHAST Step-by-Step Guide A participatory approach for the control ofdiarrhoeahttpwwwwhointwater_sanitation_healthhygieneenvsanphastepen
7 United Nations Childrenrsquos Fund httpwwwuniceforgwesindexhtml
8 WELLhttpwwwlboroacukwell
9 World Health Organizationhttpwwwwhointwater_sanitation_healthen
HYGIENE PRO
MO
TION
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005
78 BEHAVIOUR CHANGE COMMUNICATION
IN EMERGENCIES A TOOLKIT
Footnotes1 The Sphere Project Humanitarian charter and minimum standards in disaster response The
Sphere Project Geneva 20042 Harvey P et al Emergency Sanitation assessment and programme design London 2003 p 1643 World Health Organization South East Asia Regional Office Communicable Disease Profile
for Tsunami Affected Area - Indonesia Communicable Disease Team WHO AcehIndonesiaWHOSEARO Communicable Disease Working Group on Emergencies 2005
4 Adapted from Kawata as cited in Harvey et al op cit p 585 Curtis V lsquoHygiene Promotionrsquo WELL technical brief Water Engineering and Development
Centre Loughborough University 19996 Harvey et al op cit p 867 Adapted from World Health Organization lsquoGender and Health in Disasterrsquo Gender and Health WHO
Department of Gender and Womenrsquos Health 2002 p 28 United Nations Childrenrsquos Fund lsquoTowards better programming a manual on hygiene promotionrsquo
Water Environment and Sanitation Technical Guidelines Series No 6 UNICEF New York1999 p 10
9 IRC Sustainability of Hygiene Behaviour and the Effectiveness of Change InterventionsBooklet 1Delft 2004
10 Verzosa C Strategic Communications for Development Projects A toolkit for task teamleaders World Bank Washington DC 2002 p 18
11 Harvey et al op cit p 17212 Ibid p26513 Adapted from Guidelines for Public Health Promotion in Emergencies p 4714 Adapted from Guidelines for Public Health Promotion in Emergencies p 4715 The Sphere Project Humanitarian charter and minimum standards in disaster responses
The Sphere Project Geneva 2004 pp 60-6116 Humanitarian Charter and Minimum Standards in Disaster Responses pp 60-6117 Parks W Final Report on Behavioural Monitoring Workshop UNICEF Dhaka June 2005