Approaches to Approaches to Handwashing Handwashing Improvement in AfricaImprovement in Africa Global Scaling Up Handwashing Meeting Toubab Dialaw, Senegal, May 30, 2007

2

Country Overviews

3

Observed HW Behavior – Households

HWWS caregivers after toilet (%)

with water only (%)

Target with soap (%)

Barriers/facilitators

Drivers/motivations

Tanzania

6

38

Pending expanded baseline

Uganda

14

45

30

Focus on physical dirt, lack of water, 70-84% awareness of importance of HW, soap in all households, diarrhea part of growing up, soap placement

Disgust, Conformity, Safety for children, keep healthy,

feel clean (Comfort), belonging

4

Observed HW Behavior School Aged Children 6-12

After toilet with water only (%)

with soap (%)

Kenya

28

1

Tanzania

84

8

Uganda

41

5

5

Status

Stage Kenya Tanzania Uganda Partnership formation

Dec 06 Mar 06 Aug 06

Formative research Mar 07 to date Apr 06 Jan 07

Baseline Mar 07 to date Sep 07 Jan 07

Strategy development

Jul 07 Jul 07 Ongoing

Communication development

Aug 07 Aug 07 Jun 07

MIS Jul 07 Sep 07 Jul 07

Implementation Nov 07 Nov 07 Aug 07

Evaluation Nov 09 Jul 09 Feb 09

Institutionalization 5% 15% 5%

6

Kenya

Partner Contributions MOH as the lead agency with other public agencies MOE, MOWI, MOLG, MOGCSS NGOs: NETWAS, AMREF, Plan International, Practical Aid Private Sector: Unilever, Bidco, Kentainers, Roto UNICEF, WHO and UN Habitat

Funding EU $1.1 million starting FY08 WSP $200k to date

7

Tanzania

The first partnership meeting held in Mar 06, Followed by Dec 06 meeting to devise CHARTER

Partners: GoT, private sector, development partners, NGOs

The lead actors: MoW/MoH/WSP MoW:

Dedicated US$10K for HW promotion for each district An institutional home for HW within the Sanitation and

Hygiene Working Group of the WSDP MoH

Develop policies and guideline for hygiene promotion Coordinates hygiene promotion in all districts through DHO Forming the National Steering Committee for S&H

WSP Provide the seed funding for the TZ HWI Provides the coordination of the PPPHW Technical Advice, guidance

8

Tanzania

Other Partners Government

MoEVT: responsible of the school hygiene PMO-RALG: Coordinates implementation of government programme

through the LGAs

Private sector AquaSan: Provides HW sample facilities, e.g., plastic facilities Tarmal: Provides promotional materials, e.g., soap samples

International Organisations UNICEF: Provide funds for development of promotional messages,

links to additional districts PSI: Doing behavior change promotion Water Aid: Funding CBOs doing facilitation of DCC, links to additional

districts

9

Tanzania

ChallengesSustainability is the major challenge due to;

Institutional arrangement-MoW, MoHSW, PMO-RaLG,MoEVT Lack of capacity at the LGA level Lack of ministerial collaboration Weak representation of private sector Lack expertise at the local level

Opportunities Fitting in existing programmes –RWSSP,School Health

Programme,Village Health Programme Getting the PMO-RALG more involved in bridging the gap

between the stakeholder ministries Getting the HW to the parliament

10

UGANDA

HWSC was formed in 2005 as a sub-group of the National Sanitation Working group.

Chaired by MoH/EHD; Unicef, Danida, Plan International, WaterAid, UWASNET, AMREF, GTZ, DWD / MoWE & MoES are members

Progress Wrote initial HW Proposal & secured Danida seed funding Give guidance & managerial oversight to the HW campaign in Uganda Created enabling environment for Donor funding thus attracted DFID,

UNICEF and WSP funds (Danida – USD 740,000, DFID – USD 640,000, UNICEF – USD 80,000, WSP – 100,000)

A strong participation of private Sector – Unilever & Mukwano Industries

11

Constraints / Challenges Implementing partner (UWASNET) wants more independence in

implementation & handling funds (procurement), which HWSC is opposed to

Political interference - State house involvement Time-tied funds – Must spend DFID funds by 15th August 2007

What can be done better? The roles of the implementing partner and the steering committee need

to be clarified

Role of lead Government Agency UWASNET established by DWD, Danida, WaterAid & 2 other WATSAN

NGOs. UWASNET has over 130 members who are visualized to incorporate

HW into their work plans and coordinate HW activities with District structures

UGANDA

Experience of WASH Ethiopia movement to promote HW

Andreas Knapp

13

Background

1. Based on the global WASH campaign a group of like minded organizations coordinated by Water Aid decided to form the Ethiopia WASH movement

2. 2 main objectives: Advocacy movement, social mass mobilization

3. Every year the movement focused its attention on a different motto:

2004/2005 “your health is in your hands “ Reasons why hand washing was chosen as the first topic: a simple intervention to promote with direct messages; it builds on established common practices and can have a

high impact on diarrhoeal diseases. 2005/2006 “let’s use latrine for our health and dignity” 2006/2007 “keep water safe”

14

Results

Fig.3 Perceived Knowledge of respondents on "your

health is in your hands" in Ethiopia,March 2007

Knowlege of WASH motto

Do not knowKnow

Pe

rce

nta

ge

60

50

40

30

20

10

0

47

53

Fig.4 Perceived Knowledge of respondents on 'let us use

latrine for our health and dignity' in Ethiopia,March 2007

Knowledge on 1998 E.C WASH Campaign

Do not knowKnow

Perc

enta

ge

100

80

60

40

20

0

79

21

15

Regional Overview

16

Enabling Environment

Population Characteristics and HWWS Behavior

Research

Focus

Opportunity Ability Motivation

Key determinants

Marketing mix

Program Objectives

Product

Monitoring and evaluation

Price Place Promotion

Implementation

1

2

3

4

5

6

Concept & Message development

1

Channel Choice

Advocacy development

Communication Strategy

17

Link with improved water supplyLink with improved water supply

18

“It is essential that all latrine designs factor in a safe durable facility for handwashing.”

- Draft 10 YEAR UGANDA, IMPROVED SANITATION AND HYGIENE PROMOTION FINANCING

STRATEGY UGANDA

Availability of handwashing facilities Availability of handwashing facilities

19

Kenya HW initiative influencing infrastructure operations in schools. WSP facilitating Schools Infrastructure

Management Unit (SIMU) dialogue $13m from DFID to design and build pit

latrines for all 18,976 public schools in Kenya

20

Laundry Bars/Multipurpose

Toilet Soaps

50% of

revenue

Most of target audience is at “the bottom of the pyramid”

Initiative can be used to:

- bring new consumers onto toilet soap brands

- link multipurpose soaps with handwashing

Link with the soap market Link with the soap market

21

Enabling Environment

Population Characteristics and HWWS Behavior

Research

Focus

Opportunity Ability Motivation

Key determinants

Marketing mix

Program Objectives

Product

Monitoring and evaluation

Price Place Promotion

Implementation

1

2

3

4

5

6

Concept & Message development

1

Channel Choice

Advocacy development

Communication Strategy

22

Private Sector Support Private Sector Support Why is it win-win? Why is it win-win?

PUBLIC FMCG industry, highly competitive and innovative - Colgate-Palmolive, Procter & Gamble, Unilever considered schools of marketing/behavior changeSustainable handwashing with soap promotionBring divergent social and commercial marketing together to innovate behavior change

PRIVATESoap volumeInsights into B.O.P Influence and trust from governmentsSharing costs Access to national and local government structuresInsights into motivations (various theories)Staff motivation

23

How and Why Lifebuoy is leading hand washing?

BRAND VISIONMake 5 billion people feel safe & secure by meeting all their personal care hygiene &

health needs.

25

Why are we doing this?

It’s not philanthropy. It’s business with a purpose:

GUINEA BISSAU

SAUDIARABIA

IRAN

TURKEY

IRAQSYRIA

YEMEN

OMAN

JORDANISRAEL

UAEEGYPTLIBYAALGERIA

MOROCCO

SUDAN

TUNISIA

NIGER

MAURITANIA

WESTERNSAHARA

MALI

CHAD

NIGERIAETHIOPIA

SOMALIA

ERITREA

TANZANIA

UGANDA

KENYA

DJIBOUTI

COMOROS

BURKINAFASO

GHANA

COTED’IVOIRE

SENEGAL

SIERRA-LEONE

LIBERIA

TOGO

BENIN

GAMBIA

GUINEA

CENTRALAFRICAN

REPUBLIC

CAMEROON

EQUATORIAL GUINEA

GABONCONGO

DEM. REPUBLICOF CONGO

BURUNDI

RWANDA

ANGOLA

NAMIBIA

BOTSWANA

ZIMBABWE

ZAMBIA

MADAGASCAR

MOZAMBIQUE

MALAWI

SWAZILAND

LESOTHOSOUTHAFRICA

It helps us build our business in Africa, in existing and new markets

Handwashing campaigns are all about positive outlooks of what Africa can be

Influences people...to change

their behaviour (& their attitude)

27

Habit changesBrushing with toothpaste

twice a day//Handwashing before food

Which means…

& Brand choiceChoosing OMO washing powder instead of the competition

28

Through a 6 Step Process

Set The

Challenge

UnderstandWhat is(really)Going

On

Writethe

PersuasiveArgument

Generatethe

Comm.Idea

Developthe

Comm.Campaign

Implementthe

Campaign

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

29??Creating:The promise

The promotion

This Process & The ToolsThis Process & The ToolsAre always doing 2 things…

Aligning:The experts to make it

happen

1. Set the Challenge

Set The

Challenge

UnderstandWhat is(really)Going

On

Writethe

PersuasiveArgument

Generatethe

Comm.Idea

Developthe

Comm.Campaign

Implementthe

Campaign

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

31

Two things we’ve learned from a Behaviour Change perspective…

1. If you pick one audience and one behaviour you

have more chance of making change happen

2. Get as clear as you can be at this stage of:

• Exactly what it is people do NOW

• Exactly what it is you’ll want them to do in the FUTURE

2. Understand What is (really) Going on Set The

Challenge

UnderstandWhat is(really)Going

On

Writethe

PersuasiveArgument

Generatethe

Comm.Idea

Developthe

Comm.Campaign

Implementthe

Campaign

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

If we don’t get Triggers that go deep enough into people’s lives, we won’t come up with an argument with the power to persuade people to change.

3. Write the Persuasive Argument

Set The

Challenge

UnderstandWhat is(really)Going

On

Writethe

PersuasiveArgument

Generatethe

Comm.Idea

Developthe

Comm.Campaign

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

Implementthe

Campaign

35

Persuade/ v.tr. & refl.

1. (often followed by of, or that + cause) to cause (another person or oneself) to believe.

4. Generating the Communication Idea

Set The

Challenge

UnderstandWhat is(really)Going

On

Writethe

PersuasiveArgument

Generatethe

Comm.Idea

Developthe

Comm.Campaign

Implementthe

Campaign

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

37

What does a Communications Idea look like ?

Singular: one big idea for maximum impact

Versatile: works across different channels

Persuasive: to encourage the sustained behavior change we

want among our core target audience.

5. Develop the communications

campaign

Set The

Challenge

UnderstandWhat is(really)Going

On

Writethe

PersuasiveArgument

Generatethe

Comm.Idea

Developthe

Comm.Campaign

Implementthe

Campaign

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

1. Grabs Attention rather than assumes it will be given

2. Has a single idea that can be integrated across many channels

3. Meaningfully communicates the argument

A strong integrated campaign A strong integrated campaign does 3 thingsdoes 3 things

6. Implement the Campaign

Set The

Challenge

UnderstandWhat is(really)Going

On

Writethe

PersuasiveArgument

Generatethe

Comm.Idea

Developthe

Comm.Campaign

Implementthe

Campaign

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

41

Implementation means…

PlanningInvitation-Experience-Amplification

Activity Plan

Project Management

DoingKick off meeting

Project planStakeholder management/interviews

team work

LearningEvaluation of implementation

Measurement Evaluation of effect

Share & Refine

42

DeliveryDelivery Approach – based on skills Approach – based on skills development by UMAdevelopment by UMA

Learn by doing to increase retention and Learn by doing to increase retention and address risk of pull out: address risk of pull out:

Coaching for each country Live support at key program junctures All key events are regional (working towards

regional triggers/and regional briefs)

43

Marketing Expo Marketing Expo

1 day

Nairobi

For high level management working on health, water, sanitation, hygiene, and finance issues

In Safe Hands Training In Safe Hands Training

4 days

Naivasha

For practitioners in health, water and sanitation charged with implementing hygiene behavior change programs (ideally the communication team)

44

FACTS FACTS What is or isn’t happening?What is or isn’t happening?

TRIGGERTRIGGER

WHYWHY is this going on?is this going on?

Uganda Trigger WorkshopUganda Trigger Workshop

45

FACTS FACTS What is or isn’t happening?What is or isn’t happening?

Formative researchFormative research

ImmersionImmersion

46

FACTS FACTS What is or isn’t happening?What is or isn’t happening?

WHYSWHYS Why is this going on?Why is this going on?

47

48

TRIGGERTRIGGER

Uganda Trigger WorkshopUganda Trigger Workshop

•6 triggers

•4 selected for qualitative validation

•2 emerged

•1 won – process and gut feeling

•You educate your children to help you when you are old •She said she learned to raise chickens/collect reeds so that she could trade and

sell to have a better life•Father is absentee parent & mum does all including paying fees•I hope my children go to school and become successful, get good jobs & take care of me•Spends 1st on her children then on herself•She said child’s education is high on her priority list•Many women’s meetings in each village•Women’s empowerment movement in Uganda strong and supported by government

•Mothers want the best for their children and will do everything in their power to achieve it•They focus on education as they want their children to get out of the slums as they believe this will •give them a better future•She sees hope for the future in her children•Ugandan women are strong women who have overcome and still live with significant hardship and poverty•Women are surprisingly innovative when it comes to seeing to her family’s welfare •despite their strong belief of if its meant to be it will happen•Women are seen to be important in the development of the country

Mamma the Power is in Your Hands

50

UnderstandWhat is(Really)Going

On

Set The

Challenge

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

Generatethe

Comm.Idea

Implementthe

Campaign

Writethe

PersuasiveArgument

Developthe

Comm.Campaign

51

52

53

UnderstandWhat is(Really)Going

On

Set The

Challenge

ChangeHistoryAudience Role andTime Frame Effect Risk and constraints

Generatethe

Comm.Idea

Implementthe

Campaign

Writethe

PersuasiveArgument

Developthe

Comm.Campaign

54

CommunicationsIdea

PR

Sponsorship

In Communities

TV

Promotion

Outdoor Events

Radio

Leaflets

Print

55

Channel Channel Exploitation Exploitation WorkshopWorkshop

56

Achievements

Focused communication rooted in consumer understanding

Integrated campaign development Core team confidence and motivation Buy in from key partners – no more ‘bad diarrhea

communications’ Framework for regional innovation Regional motivations and insights

57

Challenges Acceptance of learning from private sector

expertise among broad HW community Integration of BC models and frameworks Linking national, health, WSS, marketing M&E

systems More focus on sustainability More knowledge sharing with other countries

starting HW programs, ie Benin, Ethiopia

58

Planned Regional Activities

FOAM Validation Workshop in Dar July Continuation of In Safe Hands - Kenya and

Tanzania Trigger workshops Development of monitoring and evaluation

framework Analysis of African HW determinants