Study on hygiene behaviour change (2003)

Proper handwashing with soap can reduce diarrhoeal diseases by over 40%.

Credit: WaterAid / Caroline Penn

WaterAid Uganda has just taken part in an international study, coordinated by the International Water and Sanitation Centre (IRC), on the sustainability of hygiene behaviour changes.

When projects are undertaken to set up new water supplies and sanitation facilities such as latrines, it is important that good hygiene practices, such as washing hands after visiting the latrine, are also promoted.

Hygiene promotion is a key part of WaterAid's ethos and is integrated into all projects. Without it, communities do not realise the full health benefits of their new facilities.

As part of the IRC study, WaterAid Uganda, along with five other non-governmental organisations (NGOs) in Ghana, India, Kenya, Nepal and Sri Lanka, visited communities it had withdrawn from three to four years earlier to ascertain whether key hygiene behaviours were still being practiced.

WaterAid Uganda found that in the three districts it visited, Mukono, Mpigi and Katakwi, close to 100% of people were still using the latrines that had been constructed. However, demonstration of handwashing had fallen to between 30% and 50%.

Washing hands after visiting the latrine is promoted.

Credit: WaterAid / Jim Holmes

The prevalence of other key hygiene practices essential for good health varied among the districts, with the key determinants of the sustainable adoption of hygiene behaviour seeming to be:

• Hygiene and sanitation programmes need to be an integral part of water supply interventions. There is a need to shift emphasis from the provision of facilities alone to the inclusion of information and education on behaviour and practices
  
• Hygiene promotion programmes should develop skills in collaboration with the existing local government structures using practical and interactive methods rather than just passing on information
  
• Children need to be specifically targeted by hygiene promotion programmes. An ideal approach is to implement hygiene and sanitation programmes in schools. Government education policies should support these programmes and children not attending school should also be specifically targeted by community based organisations
  
• Good hygiene behaviour and its benefits need to be clearly defined to communities

Lessons emerging from the study in the other five countries included:

• Women influence hygiene in the home. Therefore the formal education of girls is important
  
• It is necessary during the training in hygiene practices to emphasise the importance of passing on the information gained to friends, neighbours and other peers
  
• Government departments should be part of the project structure because communities identify with them and they are there long after the project agency has left
  
• An understanding of prevalent taboos and beliefs in a given community and the design of culturally appropriate facilities and messages is essential
  
• Interventions should preserve the dignity of women and girls
  
• Hygiene promotion messages need to be continually reinforced in order for changes in behaviour to be longlasting

'Tippy taps' such as this are easy to make and enable families to wash their hands easily.

Credit: WaterAid / Jim Holmes

All the IRC study partners, including WaterAid Uganda, are now actively disseminating the lessons learnt. This will help not only the six NGOs involved in the study, but also other organisations, refine the design of future projects to increase the sustainability of hygiene behaviour change.

The role of good hygiene in the control of water- and sanitation-related diseases is crucial, so the lessons learnt have the potential to save thousands of lives.