COVID-19 Hygiene and Behaviour Change Coalition Phase 2

The project involved four countries, three of which – Ethiopia, Zambia and Nepal – were involved in Phase 1 of the Hygiene and Behaviour Change Coalition (HBCC). Nigeria was selected for Phase 2 following previous work on hygiene behaviour change around COVID-19 under a project funded by the Heineken Africa Foundation. The countries were chosen to ensure the speed of delivery.

In partnership with Unilever, the HBCC was expanded to combat Omicron and other COVID-19 variants by continuing to focus on and rapidly deliver high-impact interventions in hygiene behaviour change, as well as building confidence in the COVID-19 vaccine, where relevant.

The proposed activities consisted of a three-pronged approach:

• Rapidly scaling up mass media communications around hygiene behaviour change and vaccination take up, delivered via TV, radio and other digital media platforms
• Delivering large-scale, face-to-face hygiene behaviour change and vaccination take up programmes to improve personal and environmental hygiene
• Building and rehabilitating sustainable, inclusive and accessible handwashing facilities in healthcare centres, schools and other key locations 
• Supporting and influencing governments and other stakeholders to improve behaviour change approaches and ensure a coordinated response 

We engaged key national government officials and organisations responsible for leading the COVID-19 response to align programme outcomes with their national priorities, to conduct formative research and to co-design behaviour change packages.

A total of 531 handwashing facilities were assessed to consider the functionality of existing resources and to inform future design, operation and maintenance of the facilities. The results of the assessments were used to plan immediate and long-term interventions.

In Ethiopia, we worked with government to monitor COVID-19 interventions in target areas.

In Nepal, we participated in a review of the urban hygiene strategy.

In Nigeria, we participated in the development of the COVID-19 vaccination communication strategy.

In Zambia, we facilitated a hygiene learning event to identify gaps and bottlenecks to achieving hand hygiene for all and discussed solutions and ways forward.

Mass communications

• Mass media campaigns used platforms such as local and national television and radio stations to encourage good hygiene practices and the take up of COVID-19 vaccinations, reaching more than 120 million people across the four countries.
• In Nepal, Nigeria and Zambia, the programme generated more than 4 million engagements on Facebook, Instagram, YouTube and TikTok.

Hygiene behaviour change

• Through community outreach engagement activities, we reached more than 2 million people through face-to-face campaigns in Ethiopia, Nepal, Nigeria and Zambia.
• With governments, we conducted research to inform national creative committees to design and test innovative and engaging behaviour change assets. These included government-approved and owned mass media and face-to-face behaviour change packages with manuals, flip charts, games and tools.
• We trained 191 government staff and community-based health workers to conduct hygiene behaviour change sessions.
• We also provided equity and inclusion training for 34 programme staff in the four countries to provide them with the knowledge and skills to improve hygiene behaviour change programming.

Hygiene facilities

• Following functionality assessments, we identified technical and management challenges and designed a response plan of rehabilitation, training and system strengthening activities.
• Disabled and older people helped us to conduct dozens of safety and accessibility audits to ensure facilities were well designed and accessible.
• We rehabilitated 291 existing handwashing facilities and built 58 news ones in healthcare facilities, schools and public places.
• Using system strengthening approaches, we worked with duty bearers to identity what was going wrong with care and maintenance and specify roles and responsibilities for improvements.

Monitoring and evaluation

With technical support from the London School of Tropical Medicine and Hygiene we conducted comprehensive and large-scale baseline and endline surveys of more than 1,250 households across the four countries to understand the practices, human motives and challenges to address.

The baseline study included household surveys and observations of actual practices, with their consent. The results of these informed the design of our behaviour change campaign design materials so that the TV, radio and face-to-face campaign engaged with people's motivations in the right way. The endline surveys were used to assess how much attitudes, behaviours and knowledge changed.

Handwashing facilities were also assessed at the baseline to inform the need for repairs and maintenance, and for system strengthening work with the duty bearer's responsible for them. We monitored these facilities on an ad-hoc basis with those duty bearers, and at the the end to see if the hardware improvements and system strengthening efforts resulted in better management. 

Our evaluations revealed that:

• Awareness of COVID-19 prevention behaviours had improved by around 25%.
• Health seeking behaviours for COVID-19 increased by 21%. (To understand these behaviours, we surveyed households to ensure they knew the symptoms of COVID-19, when to isolate, and when to seek medical attention).
• In households, handwashing after defecation improved by 7%, before eating food improved by 15% and after sneezing or coughing improved by 18%.

We supported the government-led coordination of hygiene promotion by engaging with religious and traditional leaders to raise awareness of the need for improved hygiene practices to curb the spread of COVID-19 and other infectious diseases, and the need for the government to prioritise the provision of WASH services in Bauchi state. This ended with a call from community and religious leaders for the government to prioritise WASH services to prevent the spread of diseases.

• In the states of Bauchi and Enugu, we reached more than 10 million people with radio messages and more than 8 million people through TV advertisements featuring jingles containing messages on key hygiene behaviours to reduce COVID-19 transmission and vaccine uptake.
• We reached more than 100,000 people on Facebook, Instagram, Twitter and YouTube with messages about COVID-19 vaccination.
• We also established environmental health clubs in four primary schools in Bauchi state and in two primary schools in Enugu state as part of activities to commemorate Global Handwashing Day in 2022.
• We rehabilitated 77 handwashing facilities in healthcare centres, schools and public places.
• To strengthen WASH and health integration in Bauchi state, the state’s Rural Water Supply and Sanitation Agency joined forces with the Primary Healthcare Development Agency to train 26 healthcare workers and six WASH unit staff on infection prevention and control.

Top image: Carol, 12, participates in a handwashing demonstration with her teacher in the Kazungula District of Zambia during Phase 1 of the COVID-19 Hygiene and Behaviour Change Coalition in October 2020.