About Hygiene Promotion

The potential for large impacts at modest costs

Introduction

Infectious diseases claim a lot of lives and cause many serious disabilities, some of which can be permanent, such as blindness. Eighty percent of the incidence of these diseases is related to inadequate water supply, sanitation and hygiene. The promotion of better hygiene, alone, or in combination with better water supply and/or sanitation, can have a major impact on reducing disease prevalence and public and private health costs.

Enhancing awareness and effective approaches

The first aim of the IRC Hygiene Promotion programme is to make policy-makers and programme managers more aware of the cost-effectiveness of hygiene promotion inputs for family and public health.

Comparative research has already shown that investing in the promotion of hygiene can be at least as cost-effective, by increasing productivity, as investing in vaccination or oral rehydration therapy. An investment of US$ 3 per household per year is enough to avert diarrhoea in children under five when good water and sanitation are available, and US$ 6 per year when this is not the case.[i]

The next step is to show to managers and policy makers what it actually costs to achieve an effective hygiene programme. Demonstrating the impact of hygiene promotion on public health is both time-consuming and costly. Fortunately, in the 1990s, much progress has been made in developing methods for measuring the more intermediate impacts on hygiene behaviour. A 'critical mass' (over 75%)[ii] of good hygiene and sanitation behaviours can ensure that in due course public health impacts show up in the district, national and international statistics.

Projects, programmes, and hygiene promotion as a specialisation, can greatly benefit from using hygiene behaviour measurements to demonstrate and test the effectiveness of their work. Hence, the second aim of IRC's hygiene work is to spread and further develop methods to measure behavioural change, especially through participatory (action) research.

A third aim is to increase the effectiveness of hygiene promotion interventions. Many programmes and projects still use one-way information and education methods. These have been proven to be less effective than participatory approaches based on research on adult learning, and approaches that use insights from modern marketing research. A Thematic Overview Paper (TOP) on hygiene promotion can be downloaded here.

[i]Varley, Robert C.G. & Bendahmane, Diane B. WS&S "Software" and "Hardware": The cost-effectiveness argument. EHP: an Update from USAID's Environmental Health Project. Spring, 1997.

[ii]Esrey, S.A. (1994). Complementary strategies for decreasing diarrhea morbidity and mortality: water and sanitation. Paper presented at the Pan American Health Organization, March 2-3.

Mainstreaming gender and poverty

Communities and households are not homogenous entities. Within them, different people have different opportunities, responsibilities and roles. Gender and poverty-blind hygiene promotion approaches have tended to overlook male roles, responsibilities and practices and overburden women and girls.

Hygiene promotion strategies also need to reflect the conditions and opportunities of the poor. The latter is not simply a matter of subsidies for improved hygiene facilities. In fact, subsidies often reduce access to better hygiene and health for the majority of the poor, as restricted funds can only serve a small proportion. Incorporating and responding to gender and social differences with an equity objective is a cross-cutting strategy for more effective and efficient hygiene promotion for all. It is therefore an important part of the Hygiene Promotion programme.

International co-operation

Together, twelve organisations involved in hygiene promotion have formed a Thematic Group on Hygiene Promotion - CINARA, CREPA, IRC, IWSD, Mvula Trust, NETWAS Kenya, NETWAS Uganda, NEWAH, NGO Forum Bangladesh, PCWS, SEU-F, UNICEF and WaterAid. The members held a first workshop at IRC in September 2002. Work in the subject area was shared and terms of reference developed. Several members of the group have worked on case studies and gender and poverty mainstreaming. Others prepared a joint paper for presentation at the 2003 WEDC Conference in Nigeria, on making hygiene promotion more effective,.

The work in hygiene promotion is closely related to two research projects. The first measures the sustainability of hygiene behaviour changes over time. It is carried out in Ghana, Kenya, Kerala (India), Uganda, Nepal and Sri Lanka. The partners are COSI, IRC, LSHTM, GTZ, NETWAS-Kenya, NEWAH, SEU-F, WaterAid-Uganda and VRCWSA. Funding agencies are EC and DGIS. The second research compares, as part of action research on sanitation and solid waste recycling, gender and poverty sensitive promotion with conventional promotion in coastal municipalities in Bangladesh, India and Sri Lanka. The study is a co-operation project of four universities (BUET, Bangladesh; Kuopio, Finland; Loyola College, Kerala and Peradeniya, Sri Lanka) and four NGOs (COSI, Sri Lanka; IRC, the Netherlands; NGOF, Bangladesh and SEU-F, Kerala)

Hygiene promotion is one of the subjects of the information-oriented project, WELL, (http://www.lboro.ac.uk/well/), a project funded by DfID. Partners are the Water, Engineering and Development Centre (WEDC), Loughborough University; the London School of Hygiene & Tropical Medicine; IRC; AMREF Kenya, CINARA Colombia, EHC Russia, ICDDR-B Bangladesh, IWSD Zimbabwe, NETWAS Kenya, SEU-F India, and TREND Ghana.

Recent publication

HIV/AIDS and Water, by Evelien Kamminga and Madeleen Wegelin-Schuringa was published in 2003 (updated in 2005) and is available online. A hard copy is also available.