Global Handwashing Day

Dr Valerie Curtis

LSHTM

Why HWWS?

• Some 23-40% reduction in diarrhoea risk

(Freeman et al 2014)

• Global disease burden 300 000-600 000

lives p.a.

• China: not HWWS costs $10bn, 10x ROI

• India: not HWWS costs $30bn, 20x ROI

• Prevention of pandemics and AMR

The Parable

• No messaging – no words!

• No knowledge – about emotion, reward

• Universal

• No death, disease or doctors

• Strong levers to unlock a routine

• Surprise, Revaluation, Performance

1 3 5 5

24

3 1

43

55

67 67

88 8677

0

10

20

30

40

50

60

70

80

90

100

% o

f m

oth

er

pra

ctic

ing

ta

rge

ted

be

ha

vio

ur

Before (n=120) After (119)

Source: Om Gautam, 2014

Change in safe food behaviour

Behaviour Setting

Intervention Environment

Behaviour Centred Design

BehaviourBrain Health

Assess + Build

Create

Deliver Evaluate

A

Assess

B

Build

Behaviour

C

Create

Centred

D

Deliver

Design

E

Evaluate

www.superamma.org

2%4% 6%

29%

1%

19%

37%

29%

0%

5%

10%

15%

20%

25%

30%

35%

40%

baseline 1st follow up 2nd follow up 3rd follow up

han

dw

ash

ing

at t

arge

t e

vent

s

intervention in first half of villages

intervention in control villages

19% 19%

19%

41%

21%

36%

51%

43%

0%

10%

20%

30%

40%

50%

60%

baseline 1st follow up 2nd follow up 3rd follow up

soap

use

for

han

dw

ash

ing

intervention in first half of villages

intervention in control villages

SuperAmma Results

Source: Biran et al Lancet GH 2013

View Intervention Control

HWWs is good manners 84% 21%

HWWS protects children 63% 2%

HWWS leads to success

in life

30% 0%

Everybody around here

WHWS

35% 8%

Source: Greenland et al 2015

2%4% 6%

29%

1%

19%

37%

29%

0%

5%

10%

15%

20%

25%

30%

35%

40%

baseline 1st follow up 2nd follow up 3rd follow up

han

dw

ash

ing

at t

arge

t ev

ents

intervention in first half of villages

intervention in control villages

19% 19%

19%

41%

21%

36%

51%

43%

0%

10%

20%

30%

40%

50%

60%

baseline 1st follow up 2nd follow up 3rd follow up

soap

use

for

han

dw

ash

ing

intervention in first half of villages

intervention in control villages

(6 weeks) (6 months) (12 months)

Behaviour Setting

Intervention Environment

Behaviour Centred Design

BehaviourBrain Health

Assess + Build

Create

Deliver Evaluate

Surprise Revaluation Performance

Takeaways

• Surprise, revaluation performance

• 10% of effort and investment on design

of intervention

• Private sector lessons: scale, cost, refresh

• Use professionals

• Long term policy and capacity

Thanks

• Hygiene Centre @ LSHTM: Bob Aunger,

Adam Biran, Val Curtis, Katie

Greenland, Jessie deWitt Huberts, Wolf

Schmidt, Sian White, Om Gautam,

Gaby Judah

• Funders: Wellcome, ESRC, DFID, SHARE,

World Bank, Unicef, Gates, GAIN,

WaterAid, WSSCC, Unilever, KCC, GoJo

BCD Materials

1. WWW.EHG/BehaviourCentredDesign for manual and papers : Aunger and Curtis, Kinds of Behavior, Aunger and Curtis The Anatomy of Motivation

2. Ghana handwashing ad (1990s)

https://www.youtube.com/watch?v=w2qRcMTstzc

3. Rural Indian handwashing campaign (2013)

http://www.superamma.org

4. Zambian multiple behaviour change campaign (2014)

EBF: https://www.youtube.com/watch?v=zHTwlhQdjiwORS: https://www.youtube.com/watch?v=w45PtrHUEdg

Handwashing: https://www.youtube.com/watch?v=l3jcDuU_5sc