PROMPTING BEHAVIOR CHANGE TO PREVENT THE SPREAD OF DISEASES
THE key to preventing the spread of Covid-19, and many other diseases, is in our hands— literally. It has taken a pandemic to make people realize that the simple act of washing one’s hands with soap can very well spell the difference between life and death.
Never have we been reminded so much to wash our hands than now. It’s quite fitting that this year’s Global Handwashing Day (GHD) celebration carries the theme “hand hygiene for all,” serving as a reminder to “work toward universal access and practice of handwashing with soap for now and for a healthy future,” according to the Global Handwashing Partnership (GHP), the main proponent of GHD.
The GHP, originally called the Global Public- Private Partnership for Handwashing ( PPPHW), stemmed from two large- scale handwashing campaigns in Burkina Faso, West Africa and Central American countries Guatemala, Costa Rica, and El Salvador, which showed the positive impact of washing hands with soap on disease prevention.
The power of research
THE Burkina Faso project, dubbed Programma Saniya, did careful consumer research prior to rollout, leading to more targeted handwashing program activities that yielded amazing results in terms of knowledge retention, behavior change, and disease prevention. The simple behavior modification activity that the project pushed: washing hands with soap after changing diapers, targeted specifically at mothers and caregivers of infants and toddlers.
According to a paper titled, “Evidence of Behaviour Change Following a Hygiene Promotion Programme in Burkina Faso,” published in the Bulletin of the World Health Organization in 2001, the program was triggered by the high incidence of childhood diarrhea in the town of Bobo- Dioulasso. Quantitative and qualitative studies were done from 1989-1994, the results of which were used to guide the Ministry of Health and Community Groups in formulating clear objectives, specific target audiences, appropriate messaging, and overall strategy to promote safer hygiene practices.
The target audiences were segmented into primary, secondary, and tertiary groups, with very clear demographic and psychographic characteristics. For the primary target audiences— composed of mothers, older sisters, and maids taking care of children aged zero35 months— the program latched onto one key motivation to spur behavior change: the social and aesthetic desirability of hygiene. Based on insights from the prerollout qualitative research, this audience group appeared to value hygiene for its social and aesthetic impacts, and not really as a means to avoid diarrhea.
“Messages were thus bui lt around the idea of the respect they might gain from being hygienic, and the improvements gained in quality of life when fecal material was removed and could therefore not be seen or smelt,” the WHOpublished paper stated. “Although the germ theory of disease did not figure in messages aimed at adults, it did form a part of the hygiene curriculum for schools.”
There were only two main messages for this campaign: (1) Hands should be washed after contact with stools, and (2) Stools in potties should be disposed of safely in latrines. These were communicated and amplified via various channels, including neighborhood hygiene commissions with houseto- house visits, discussion groups in health centers and in the community, street theater, local radio spots and programs, and a hygiene curriculum in primary school. These channels were identified following a series of focus group discussions and a small, population- based survey.
From the start of the campaign in August 1995 until its end three years later, the incidence of handwashing with soap significantly increased, vis- à-vis relevant program objectives.
“After the program, 31 percent of mothers were observed using soap after handling children’s stools compared with 13 percent before cleaning children, and from 33 percent to 67 percent after using the latrine,” the paper stated. The program aimed to increase the incidence of handwashing with soap after cleaning a child’s bottom from 13 percent to 30 percent, and after using the latrine from 1 percent to 15 percent.
The GHP further said that this campaign “averted 9,000 diarrheal episodes, 800 outpatient visits, and 100 deaths. These results were achieved at a cost of US$0.30 per participant.”
PPP in advocacy
THE other project, called the Central American Handwashing for Diarrheal Disease Prevention Program, was a collaborative undertaking among ministries of health and education in Guatemala, Costa Rica, and El Salvador, local and multinational soap manufacturers, and nongovernment organizations ( NGOS). The United States Agency for International Development ( USAID) conceptualized and facilitated the campaign through two of its projects: Basic Support for Institutionalizing Child Survival ( BASICS) and the Environmental Health Project ( EHP).
A paper titled “The Story of a Successful Public- Private Partnership in Central America: Handwashing for Diarrheal Disease Prevention” provided details of the campaign, from conceptualization to implementation to assessment of results. As with Programma Saniya, this campaign was likewise anchored on consumer- centric research, but beefed up with public sector and NGO alliances.
“The effort was based on the belief that private commercial firms and public entities [principally ministries of health] would find it mutually beneficial to work in partnership to achieve complementary goals in promoting handwashing for public health,” the paper stated.
“Soap companies would use new messages and methods of advertising soap designed to reach groups with low socioeconomic status in rural areas where diarrheal disease rates were high. These efforts would help each company increase sales and enhance its corporate image. The public sector would endorse the promotional campaign, assist in dissemination, and collaborate in special interventions— such as distribution of handwashing kits. The partnership would provide the public sector with new resources,” it added.
It was a win- win for all parties involved at the end of the campaign’s three-year run in 1999, as, based on a follow- up assessment, 10 percent of the women surveyed claimed an improvement in their handwashing behavior. The paper estimated that because of this behavior change, the campaign was able to reduce the incidence of diarrhea in children under five years old by 4.5 percent.
The success of these two campaigns not only gave rise to the establishment of the GHP, but also placed on the international development program map the importance of the simple act of handwashing with soap as an affordable and accessible means to stop the spread of diseases. For the first time, hygiene made it into the United Nations Sustainable Development Goals under Goal 6, or to ensure availability and sustainable management of water and sanitation for all.
Local efforts
THE Philippines has been an active participant in GHD celebrations since its inception in 2008. Many private companies, mostly soap manufacturers, have their own way of advocating proper handwashing. Maynilad, the company I work for, chose grade school students as the primary target audience for our advocacy, as we believe that instilling the value of proper handwashing early in life can yield far- reaching results— both well into the future and in the here and now.
For our Daloy Dunong campaign, we use a puppet show to deliver W. A. S. H. (water, sanitation, and hygiene) messages, to make learning fun and engaging. The mode of delivery is particularly important, as we’re dealing with children who have short attention spans.
We couple this education campaign with an infrastructure program called Lingkod Eskwela, which involves building drinkand- wash stat ions in publ ic schools within our service area. Because how can the students practice what they’ve learned when they don’t have access to the required facilities? Both of these programs are aligned with the Department of Education’s W. A. S. H. in Schools ( Wins) program.
For this year’s GHD celebration, since we can’t physically go to the schools to engage with students, we brought our advocacy online. With the help of Philpop Musicfest Foundation, we came out with a 20- second handwashing jingle that people can sing while washing their hands, so they can be sure to eliminate any germs or viruses that they may have picked up. We added some simple choreography, and posted a video on various social- media platforms.
“Handwashing with soap can help reduce the transmission of a range of diseases: Handwashing is also key in the fight against Covid-19. Handwashing with soap destroys the outer membrane of the virus and thereby inactivates it. One study found that regular handwashing with soap can reduce the likelihood of Covid-19 infection by 36 percent,” the GHP said.
You can never wash your hands too much, especially at a time like this. Knowing that this simple act can help save your and your family’s lives should be reason enough to stick to the habit, even after we find a vaccine for Covid-19.
PR Matters is a roundtable column by members of the local chapter of the United Kingdom- based International Public Relations Association ( Ipra), the world’s premier organization for PR professionals around the world. Abigail L. Ho-torres is AVP and Head of Advocacy and Marketing of Maynilad Water Services Inc. She spent more than a decade as a business journalist before making the leap to the corporate world.
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