Hygiene Promotion (HP) in Emergencies is a planned, systematic approach that enables people to take action and encourages behaviours or conditions that prevent or mitigate WASH-related diseases. Hygiene promotion aims to support the dignity and wellbeing of emergency affected populations and no WASH intervention should be undertaken without including it. More in-depth information on all aspects of HP in emergencies can be found in the recently published Compendium of Hygiene Promotion in Emergencies – a comprehensive compilation of the most relevant and sector-reviewed HP components, tools, methods and approaches drawing on latest initiatives, materials and evidence.
Hygiene promotion that supports behaviours, community engagement and actions to reduce the risk of disease is fundamental to a successful WASH response.
Hygiene promotion aims to ensure the effective, sustained and optimal use of WASH facilities by all users. If water, toilets or handwashing facilities are provided without consideration of the context or users, they may not be used optimally by all members of the community. Nor will they be maintained.
Hygiene promotion aims to involve people in decisions about the WASH or outbreak response, such as the design, siting and management of facilities or how best to communicate with a community. It enables affected communities to participate in the programme.
Hygiene promotion can identify different needs and concerns within the affected population, so that the programme responds to those needs and helps to increase equitable access to WASH.
Hygiene promotion provides a mechanism to actively listen and respond to feedback from different community members. It can increase the accountability of the response. There is always an opportunity for dialogue and discussion with those affected – even in the acute phase of an emergency when it can be overlooked.
Hygiene promotion carries out formative assessments to understand and respond to the social and behavioural determinants that affect people’s health and hygiene in a specific context.
Hygiene promotion’s emphasis on community engagement and participation can link humanitarian work to longer-term development.
Hygiene promotion may be one of the most cost-effective ways of improving public health outcomes.
Hygiene Promotion is also well placed to respond to broader public health programming and to the outbreak of diseases, such as Ebola or COVID-19, where a comprehensive emergency WASH intervention may not be required.
Hygiene promotion is intertwined with community engagement which connects the community and other stakeholders so that people affected by the crisis have more control over the response and its impact on them. It should be supported by all involved in the response including government, local or international agencies and non-governmental organisations (NGOs).
With the adoption of the 2030 Agenda for Sustainable Development the ‘leave no one behind’ principle has been widely adopted in the WASH sector to ensure that the most vulnerable populations have access to basic services; it is therefore an important part of hygiene initiatives. Hygiene promotion recognises the differences within any population and the necessity to respond in various ways to the different WASH needs of women and men, girls and boys of different ages from different backgrounds, with different cultural and social norms, beliefs, religions, abilities, gender identities or levels of self-confidence and self-efficacy.
Hygiene promotion’s emphasis on the importance of listening to affected communities and its use of dialogue and discussion provide a practical way of facilitating participation and accountability. It gives people a voice and involves them in making decisions about the way the programme is delivered (e.g. about the design, siting, operation and management of WASH facilities).
Hygiene promotion should aim to understand the enablers and barriers to behaviour change so that programmes do not just focus on the provision of information and increasing knowledge but on working supportively with communities to understand how change can best be achieved. Hygiene promotion may therefore also consider other determinants of health and hygiene such as socio-economic, environmental and psychological barriers and enablers.
Key HP components include:
Preconditions and Enabling Factors are the resources, processes, services and infrastructural prerequisites that enable the relevant hygiene practices of an affected population and support good hygiene outcomes. They include the provision of adequate water and sanitation infrastructure, the ability of local markets to supply hygiene consumables and WASH services and Coordination with other humanitarian WASH actors, local service authorities, service providers and other sectors.
Community Engagement and Participation are dynamic processes that connect the community with itself and other stakeholders so that people affected by the crisis are empowered and have more control over the response and its impact on them (Sphere 2018). Community participation and engagement processes listen to and enable different community groups to influence WASH programme decisions. Community engagement increases programme effectiveness by recognising and harnessing the communities’ capacities, needs and priorities and, ultimately, by empowering them.
Assessment, Analysis and Planning aim to understand the WASH vulnerabilities and capacities of affected populations and to identify how best to prioritise and respond to their diverse and changing needs. It is a continuous process that should shape and inform the WASH Programme.
Communication facilitates HP through active listening, information exchange and guidance and advice to target audiences, enabling them to develop positive hygiene behaviours and practices. Information is a highly valued commodity during emergencies and communication is an important element of it. Communicators need strategies and tactics to create effective messages which motivate the target audience to protect families, communities and whole societies in an emergency.
Social and Behaviour Change aims to understand the barriers and motivators for change and to enable individuals and communities to practise safer hygiene. Strategies to trigger and motivate change draw on a variety of factors and focus both on the individual and the predisposing and enabling factors. Hygiene behaviour change can be defined as an adoption or increase in hygiene behaviours and a decrease in risky behaviours for a defined target population. The ideal outcome of hygiene behaviour change is that all individuals in the target population consistently and habitually practice the intended behaviours and thereby protect themselves against communicable diseases.
Monitoring, Evaluation, Accountability and Learning (MEAL) are key components of all humanitarian programmes. Together, they support the WASH programme to achieve its objectives to promote healthy behaviours and prevent illness. MEAL guides the programme so that it continues to be appropriate and responsive to the needs and vulnerabilities of the affected population.
Process & Good Practice
- Understand the affected community’s different perspectives on sanitation and hygiene and involve them in decisions about the programme.
- Listen and ask: It is vital to learn about sanitation practices and norms. For example: what do different people usually do? What is happening now and what has changed as a result of the emergency? What do different people need and want to ensure that sanitation facilities are effective and have an impact on health? What are the priority sanitation risks? Who are the most vulnerable and what support do they need to access sanitation services and facilities? Who can help e.g. the affected population (who also have skills and capacities), local agencies or government departments? It is important not to treat everyone the same but to identify different groups to work with e.g. youth, mothers and fathers of young children, religious leaders, primary school children, canteen workers, hairdressers etc.
- Involve and enable action: Interactive discussions can be used to support different user groups to identify what they can do immediately to improve sanitation and hygiene. It is important to find out what is potentially stopping them from acting (the barriers and obstacles to improved sanitation and hygiene) and to find out what help they need, if any. By conducting surveys and differentiating between doers and non-doers, users and non-users of facilities, drivers can be identified that motivate action. Supporting community initiatives is also useful and can help to ensure that people motivate each other. A variety of interventions can help to respond to the immediate risks but will depend on the context e.g. interim sanitation solutions, tools for digging pits, soap or alternatives for handwashing, potties or nappies for children etc. Consider how sanitation and hygiene facilities will be maintained from the beginning and the community’s involvement in this e.g. through the formation of committees or user groups.
- Focus on vulnerability: It is vital to identify people with specific needs (e.g. women and girls, older people, and people with disabilities) and find out what they feel and need to manage their sanitation and hygiene needs (e.g. Menstrual Hygiene Management). Incorporating Gender and diversity is particularly important. Ensuring that you have women on the team will mean they can talk more easily with other women. Finding out how babies’ and young children’s excreta is managed and asking mothers and caregivers what support they want to do this effectively, is also crucial. Work with local organisations representing vulnerable groups such as disabled people’s organisations. Involving a diverse group of affected people in discussions about the assessment findings and understanding their concerns early on is important to review plans and decide together on realistic and context-specific options.
- Plan together: Setting practical objectives and indicators and compiling a WASH strategy with others involved in the WASH response are also key processes in an HP intervention. In this process, the ‘doable’ actions that can have an impact on sanitation and hygiene should be identified and how effectiveness will be monitored should be decided. The affected community should contribute to this strategy. The recruitment, training and support of existing and new team members will help to ensure that plans come to fruition.
- Collaborate and coordinate to implement: A variety of methods and tools can be used to work with different groups to motivate action to improve and effectively use and maintain sanitation facilities and services for women and men, people in different age groups and with different abilities. Working closely with others involved in the response, especially the Government, international, national and local WASH actors and other relevant sectors, is crucial. It facilitates the timely delivery of WASH services and enables participation, reduces duplication and helps to prioritise interventions. It should be possible to undertake joint activities such as assessments or evaluations or HP outreach workers may focus on other priority health issues as well as hygiene.
- Monitor and review: By means of observation (Do people use the facilities?) and surveys (Did people change their behaviour?) the effectiveness of HP and behaviour change efforts can be monitored. Continually seeking feedback from the population will enable adaptations in programming and improve effectiveness. It is also important to keep track of any rumours that might be detrimental and to respond to these as soon as possible e.g. by incorporating them into discussions with community groups or providing information on social media.
- Be empathic with the affected population and try to understand their perspectives. Active listening is a vital component of communication; listening, rather than simply providing information, should be HP’s starting point.
- Understand the preconditions and enabling factors of envisioned hygiene practices (such as access to facilities and markets) and be realistic about what is possible in their absence.
- Recognise the importance of the social and behavioural determinants of hygiene. Assess and monitor barriers and motivators for change; most of the HP frameworks draw on a model of behaviour change. All these factors must be included in an HP programme.
- Aim to understand the local context and existing capacity and find out who is affected, their needs and vulnerabilities, the affected communities‘ perceptions, existing norms, leadership structures and priorities. The coping strategies of the communities and their capacities can be mapped out so that interventions address gaps in hygiene facilities, services and corresponding behaviours.
- Ensure the availability of HP personnel with appropriate communication and HP skills and expertise (whether volunteers or paid staff).
- Include community capacity strengthening in the programme to enable sufficient levels of participation, engagement and skills. For all WASH facilities, at a community or institutional level, a feeling of ownership and management responsibility is critical for the continued functionality of the services.
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