Beyond business as usual for handwashing
This April, WaterAid, the London School of Hygiene and Tropical Medicine, and the Global Public-Private Partnership for Handwashing co-sponsored the 2016 Annual Handwashing Think Tank. Om Prasad Gautam, WaterAid’s Technical Support Manager for Hygiene, and Hanna Woodburn, Secretariat Director at the Global Public-Private Partnership for Handwashing, present new thinking and the key topics discussed.
The UN’s agreement of Sustainable Development Goal (SDG) 6, specifically Target 6.2 calling on the global community to achieve access to adequate and equitable sanitation and hygiene for all by 2030, is a great step.
But if we hope to reach this worthwhile goal, we must break out of our ‘business as usual’ approach towards addressing the issues. Especially for hygiene, which was not included in the Millennium Development Goals, we must take stock of what we know about behaviour change, identify the gaps, and explore how we can translate our knowledge into action.
In pursuit of these ends, WaterAid, the London School of Hygiene and Tropical Medicine, and the Global Public-Private Partnership for Handwashing co-sponsored the 2016 Handwashing Think Tank on 12-13 April 2016.
The Think Tank, held annually, tackles big ideas in handwashing behaviour change, with the objective of driving the sector forward. This year, three thematic areas were discussed:
The combination of the efforts and resources of sectors to align priorities, strategies, and interventions of similar but potentially competing programmes, to maximise outcomes.
The attributes that define physical, biological, and social environment; possessing an understanding of one’s settings can impact changes in behaviour and trigger adoption of critical practices.
Scale refers to the capacity to increase the rate of progress and expand the approach of the intervention from the target population to a larger scale (i.e. an entire population). Sustainability refers to the ability of a target population to maintain an intervention or practice beyond the life of a programme without outside financial or technical assistance.
Experts exploring the cutting edge of each of these topics gave brief presentations, and participants worked together to identify gaps and challenges, and articulated how the sector should respond.
Key themes from the think tank
Over the two days of the workshop, a few key areas of consensus emerged.
- Integrating handwashing into related sectors and programming, such as neonatal care, nutrition, education, and sanitation, will be essential to meeting SDG Target 6.2. Not only is integration important to achieving scale, but it also impacts on sustainability.
However, this is easier said than done. Although integrating handwashing into neonatal health and wellness interventions, for instance, makes good sense as a way to prevent deadly infections, there is still a dearth of evidence around key factors: What are the critical times? Whose hand cleanliness is most important in the household and institutions such as health-care settings? How do we promote handwashing when there are a range of behaviours that are important in this context?
- Disturbing the setting is an important concept for changing behaviour. It involves creating desire within the community to foster a social norm that encourages, prompts, and reinforces handwashing behaviour and practices. However, behaviour change programmes that promote handwashing with soap continue to face challenges. Behaviour-centred design, a framework for assessing, designing, implementing and evaluating behaviour change intervention, can allow gaps to be overcome: – What ‘roles’ and ‘narratives’ can be promoted that aren’t necessarily health-related – for instance, is there a way to connect with women who want to be role models, who would be keen to be seen promoting equality and demonstrating good hygiene behaviours? – What is the sustainability of environmental cues, i.e. how effectively can physical settings be changed and behavioural products (such as soap, handwashing station, water) be ensured, and how can the social desire be triggered and continuously reinforced using visual reminders for behaviour change?
- Ensuring that programmes for handwashing with soap are sustainable and scalable will require implementers to assess whether all actors (e.g. civil society, the private sector, governments, community-based organisations, etc.) are represented and consulted in both the design of interventions and the implementation of programming, and that their strengths are being used to inspire co-innovation. However, before scale and sustainability can be effectively attained, major challenges to measuring programmes, including funding for long-term evaluation and institutional mechanism for behaviour reinforcement, must be addressed, and an approach must be in place to tap into the aspirations of the target population.
- Behaviour change outcome measurement was an important conversation consistent throughout the Think Tank. We know that ‘what gets measured gets done’. And so, especially with the SDGs, it is vital that the availability of handwashing stations with soap and water is measured.
However, access to handwashing stations does not guarantee use. The behaviour of handwashing is especially difficult to measure accurately, and, as a sector, we need to continue to address this challenge.
Solid facts into solid action
The facts about handwashing are clear – it not only protects health, but also impacts nutrition, education, and equity. And, in addition to being effective, it is affordable and accessible.
Yet, despite the clear benefits of hygiene, far too often it is not prioritised, from the personal level to the policy level. The Handwashing Think Tank sought to rectify this by shining a light on new thinking about handwashing and behaviour change, on which implementers can act.
We hope that the Think Tank has started important discussions around handwashing integration, settings, scale/sustainability and behaviour change outcomes measurement that will help us learn how we can continue to improve handwashing behaviour change, and ultimately trigger action.