Approaches to Handwashing Improvement in Africa Global Scaling

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

Country Overviews 2

Observed HW Behavior – Households HWWS caregivers after toilet (%) with water only (%) Target with soap (%) Barriers/facilitators Drivers/motivations Tanzania 6 Uganda 14 38 45 Pending expanded baseline 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 3

Observed HW Behavior School Aged Children 6 -12 Kenya Tanzania Uganda After toilet with 28 water only (%) 84 41 with soap (%) 8 5 1 4

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 Ongoing Communication development Aug 07 Jun 07 MIS Jul 07 Sep 07 Jul 07 Implementation Nov 07 Aug 07 Evaluation Nov 09 Jul 09 Feb 09 Institutionalization 5% 15% 5% 5

Kenya Partner Contributions v v v 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 v EU $1. 1 million starting FY 08 v WSP $200 k to date 6

Tanzania v The first partnership meeting held in Mar 06, Ø Followed by Dec 06 meeting to devise CHARTER v Partners: Go. T, private sector, development partners, NGOs v The lead actors: Mo. W/Mo. H/WSP v Mo. W: Ø Dedicated US$10 K for HW promotion for each district Ø An institutional home for HW within the Sanitation and Hygiene Working Group of the WSDP v Mo. H Ø Develop policies and guideline for hygiene promotion Ø Coordinates hygiene promotion in all districts through DHO Ø Forming the National Steering Committee for S&H v WSP Ø Provide the seed funding for the TZ HWI Ø Provides the coordination of the PPPHW Ø Technical Advice, guidance 7

Tanzania Other Partners v Government Ø Mo. EVT: responsible of the school hygiene Ø PMO-RALG: Coordinates implementation of government programme through the LGAs v Private sector Ø Aqua. San: Provides HW sample facilities, e. g. , plastic facilities Ø Tarmal: Provides promotional materials, e. g. , soap samples v International Organisations Ø UNICEF: Provide funds for development of promotional messages, links to additional districts Ø PSI: Doing behavior change promotion Ø Water Aid: Funding CBOs doing facilitation of DCC, links to 8 additional districts

Tanzania v Challenges Sustainability is the major challenge due to; Ø Ø Ø Institutional arrangement-Mo. W, Mo. HSW, PMO-Ra. LG, Mo. EVT Lack of capacity at the LGA level Lack of ministerial collaboration Weak representation of private sector Lack expertise at the local level v Opportunities Ø Fitting in existing programmes –RWSSP, School Health Programme, Village Health Programme Ø Getting the PMO-RALG more involved in bridging the gap between the stakeholder ministries Ø Getting the HW to the parliament 9

UGANDA v HWSC was formed in 2005 as a sub-group of the National Sanitation Working group. v Chaired by Mo. H/EHD; Unicef, Danida, Plan International, Water. Aid, UWASNET, AMREF, GTZ, DWD / Mo. WE & Mo. ES are members Progress v Wrote initial HW Proposal & secured Danida seed funding v Give guidance & managerial oversight to the HW campaign in Uganda v 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) v A strong participation of private Sector – Unilever & Mukwano Industries 10

UGANDA Constraints / Challenges v Implementing partner (UWASNET) wants more independence in implementation & handling funds (procurement), which HWSC is opposed to v Political interference - State house involvement v Time-tied funds – Must spend DFID funds by 15 th August 2007 What can be done better? v The roles of the implementing partner and the steering committee need to be clarified Role of lead Government Agency v UWASNET established by DWD, Danida, Water. Aid & 2 other WATSAN NGOs. v UWASNET has over 130 members who are visualized to incorporate HW into their work plans and coordinate HW activities with District structures 11

Experience of WASH Ethiopia movement to promote HW Andreas Knapp

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: v 2004/2005 “your health is in your hands “ Ø Reasons why hand washing was chosen as the first topic: Ø a simple intervention to promote with direct messages; Ø it builds on established common practices and can have a high impact on diarrhoeal diseases. v 2005/2006 “let’s use latrine for our health and dignity” v 2006/2007 “keep water safe” 13

Results 14

Regional Overview 15

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Link with improved water supply 17

Availability of handwashing facilities “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 18

Kenya HW initiative influencing infrastructure operations in schools. WSP facilitating Schools Infrastructure Management Unit (SIMU) dialogue § $13 m from DFID to design and build pit latrines for all 18, 976 public schools in Kenya 19

Link with the soap market Most of target audience is at “the bottom of the pyramid” Initiative can be used to: 50% of revenue Toilet Soaps - bring new consumers onto toilet soap brands - link multipurpose soaps with handwashing Laundry Bars/Multipurpose 20

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Private Sector Support Why is it win-win? PUBLIC v. FMCG industry, highly competitive and innovative Colgate-Palmolive, Procter & Gamble, Unilever considered schools of marketing/behavior change v. Sustainable handwashing with soap promotion v. Bring divergent social and commercial marketing together to innovate behavior change PRIVATE v. Soap volume v. Insights into B. O. P v Influence and trust from governments v. Sharing costs v. Access to national and local government structures v. Insights into motivations (various theories) v. Staff motivation 22

How and Why Lifebuoy is leading hand washing? 23

BRAND VISION Make 5 billion people feel safe & secure by meeting all their personal care hygiene & health needs.

Why are we doing this? TURKEY TUNISIA v It’s not philanthropy. It’s business with a purpose: SYRIA MOROCCO ISRAEL IRAQ IRAN JORDAN ALGERIA LIBYA EGYPT SAUDI ARABIA WESTERN SAHARA OMAN MAURITANIA SUDAN MALI NIGER GUINEA BISSAU GUINEA Ø It helps us build our business in Africa, in existing and new markets Ø Handwashing campaigns are all about positive outlooks of what Africa can be SIERRA-LEONE YEMEN ERITREA CHAD SENEGAL GAMBIA UAE DJIBOUTI BURKINA FASO BENIN COTE D’IVOIRE LIBERIA ETHIOPIA CENTRAL AFRICAN REPUBLIC NIGERIA SOMALIA CAMEROON GHANA TOGO UGANDA EQUATORIAL GUINEA GABON CONGO KENYA BURUNDI DEM. REPUBLIC OF CONGO RWANDA TANZANIA COMOROS ANGOLA MALAWI ZAMBIA ZIMBABWE NAMIBIA BOTSWANA MADAGASCAR MOZAMBIQUE SWAZILAND SOUTH AFRICA LESOTHO 25

Influences people. . . to change their behaviour (& their attitude)

Which means… v Habit changes ØBrushing with toothpaste twice a day//Handwashing before food v & Brand choice ØChoosing OMO washing powder instead of the competition 27

Through a 6 Step Process Understand Set What is The (really) Challenge Going On Write the Persuasive Argument Generate the Comm. Idea Develop the Comm. Campaign Implement the Campaign Change History Audience Role and Time Frame Effect Risk and constraints 28

This Process & The Tools Are always doing 2 things… Creating: The promise The promotion ? Aligning: The experts to make it happen 29

1. Set the Challenge Set The Challenge Change History Audience Role and Time Frame Effect Risk and constraints Understand What is (really) Going On Write the Persuasive Argument Generate the Comm. Idea Develop the Comm. Campaign Implement the Campaign

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 31

2. Understand What is (really) Going on Set The Challenge Change History Audience Role and Time Frame Effect Risk and constraints Understand What is (really) Going On Write the Persuasive Argument Generate the Comm. Idea Develop the Comm. Campaign Implement the Campaign

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.

Develop Generate 3. Write Persuasive Argument Implement the Understand Set What is The (really) Challenge Going On Change History Audience Role and Time Frame Effect Risk and constraints the Persuasive Argument the Comm. Idea Comm. Campaign the Campaign

Persuade/ v. tr. & refl. 1. (often followed by of, or that + cause) to cause (another person or oneself) to believe. 35

4. Generating the Communication Idea Set The Challenge Change History Audience Role and Time Frame Effect Risk and constraints Understand What is (really) Going On Write the Persuasive Argument Generate the Comm. Idea Develop the Comm. Campaign Implement the Campaign

What does a Communications Idea look like ? v Singular: one big idea for maximum impact v Versatile: works across different channels v Persuasive: to encourage the sustained behavior change we want among our core target audience. 37

5. Develop the communications campaign Understand Set What is The (really) Challenge Going On Change History Audience Role and Time Frame Effect Risk and constraints Write the Persuasive Argument Generate the Comm. Idea Develop the Comm. Campaign Implement the Campaign

A strong integrated campaign does 3 things 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

6. Implement the Campaign Understand Set What is The (really) Challenge Going On Change History Audience Role and Time Frame Effect Risk and constraints Write the Persuasive Argument Generate the Comm. Idea Develop the Comm. Campaign Implement the Campaign

Implementation means… Planning Invitation-Experience-Amplification Activity Plan Project Management Learning Evaluation of implementation Measurement Evaluation of effect Share & Refine Doing Kick off meeting Project plan Stakeholder management/interviews team work 41

Delivery Approach – based on skills development by UMA Learn by doing to increase retention and address risk of pull out: v Coaching for each country v Live support at key program junctures v All key events are regional (working towards regional triggers/and regional briefs) 42

Marketing Expo 1 day Nairobi In Safe Hands Training 4 days Naivasha For high level management working on health, water, sanitation, hygiene, and finance issues For practitioners in health, water and sanitation charged with implementing hygiene behavior change programs (ideally the communication team) 43

Uganda Trigger Workshop TRIGGER WHY is this going on? FACTS What is or isn’t happening? 44

Formative research Immersion FACTS What is or isn’t happening? 45

WHYS Why is this going on? FACTS What is or isn’t happening? 46

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Uganda Trigger Workshop TRIGGER • 6 triggers • 4 selected for qualitative validation • 2 emerged • 1 won – process and gut feeling 48

Mamma the Power is in Your Hands • 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 • 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 1 st 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

Understand Set What is The (Really) Challenge Going On Write the Persuasive Argument Generate the Comm. Idea Develop the Comm. Campaign Implement the Campaign Change History Audience Role and Time Frame Effect Risk and constraints 50

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Understand Set What is The (Really) Challenge Going On Write the Persuasive Argument Generate the Comm. Idea Develop the Comm. Campaign Implement the Campaign Change History Audience Role and Time Frame Effect Risk and constraints 53

In Communities Promotion Print TV Leaflets Communications Idea PR Events Radio Outdoor Sponsorship 54

Channel Exploitation Workshop 55

Achievements v Focused communication rooted in consumer understanding v Integrated campaign development v Core team confidence and motivation v Buy in from key partners – no more ‘bad diarrhea communications’ v Framework for regional innovation v Regional motivations and insights 56

Challenges v Acceptance of learning from private sector expertise among broad HW community v Integration of BC models and frameworks v Linking national, health, WSS, marketing M&E systems v More focus on sustainability v More knowledge sharing with other countries starting HW programs, ie Benin, Ethiopia 57

Planned Regional Activities v FOAM Validation Workshop in Dar July v Continuation of In Safe Hands - Kenya and Tanzania Trigger workshops v Development of monitoring and evaluation framework v Analysis of African HW determinants 58