Category Archives: Hygiene Promotion

SuSanA webinar monthly webinar 1: “Opportunities & challenges of achieving WASH behaviour change”

Published on Apr 28, 2016

The webinar brought together speakers who presented their perspectives on how we can improve WASH behavior change. First, we learnt about how we can do a better job of leveraging the influence of community leaders to change some of the social and cultural norms that prevent uptake of healthy WASH behaviors. The role of both formal and informal leaders was explored, as well as how to extend this collaboration beyond CLTS to incorporate it more into other WASH approaches.

Disgust, Shame, and Soapy Water: Tests of Novel Interventions to Promote Safe Water and Hygiene

Disgust, Shame, and Soapy Water: Tests of Novel Interventions to Promote Safe Water and HygieneJournal of the Association of Environmental and Resource Economists 3, no. 2 (June 2016): 321-359. Authors: Raymond P. Guiteras, David I. Levine, Stephen P. Luby, et al.

Lack of access to clean water is among the most pressing environmental problems in developing countries, where diarrheal disease kills nearly 700,000 children per year. While inexpensive and effective practices such as chlorination and hand washing with soap exist, efforts to motivate their use by emphasizing health benefits have seen only limited success.

This paper measures the effect of messages appealing to negative emotions (disgust at consumption of human feces) and social pressure (shame at being seen consuming human feces) on hand-washing behavior and use of and willingness to pay for water chlorination among residents of slum compounds in Dhaka, Bangladesh.

Neither the traditional, health-based message nor the new disgust-and-shame message led to high levels of chlorination during a free trial, nor to high willingness to pay for the chlorine at the end of the free trial. Provision of low-cost hand-washing facilities did increase hand washing, although the effect size is modest.


PPPHW – The State of Handwashing in 2015

The State of Handwashing in 2015. Global Public-Private Partnership for Handwashing.

In this summary, we outline key themes and findings from 44 peer-reviewed handwashing-related research papers published globally in 2015 and specifically relevant in low and middle-income countries. handwashing

These findings can be categorized by five key themes:

  • Benefits of handwashing with soap
  • Measuring handwashing behavior
  • Approaches to handwashing behavior change
  • Handwashing station sustainability
  • Handwashing in the emergency setting

New tactics to nudge habit change for open defecation behavior

New tactics to nudge habit change for open defecation behavior | Source: World Bank Water Blog, March 31 2016 |

Open defecation remains a critical global health challenge, affecting almost 1 billion people around the world and contributing significantly to the estimated 842,000 people who die each year because of poor sanitation, hygiene practices, and unsafe water supplies.


Public toilet in the shanty town of Ciudad Pachacutec, Ventanilla District, El Callao Province – Peru Photo: Monica Tijero / World Bank

Most behavior change approaches and frameworks for addressing open defecation have focused on relatively conscious, “reflective”  drivers of behavior, including people’s emotions (such as pride or shame), rational knowledge (e.g., of germ theory), social norms, and explicit action plans (such as commitments to change).

Using the framework popularized by renowned social psychologist Daniel Kahneman, these factors can be described as “System 2” drivers of behavior i.e., relatively conscious and motivational factors. It is now well established, however, that human behavior can also be heavily influenced by “System 1” drivers i.e., relatively automatic, cue-driven factors.

In a newly released working paper by the World Bank Water Global Practice’s Water and Sanitation Program (WSP)Nudging and Habit Change for Open Defecation: New Tactics from Behavioral Science”, we draw on basic scientific findings from psychology, cognitive science, and behavioral economics to propose a framework of eight “System 1” principles to support the initiation and maintenance of open defecation behavior change.

In doing so, the new working paper builds from the general framework advanced in the World Bank Group’s 2015 World Development Report “Mind, Society, and Behavior”, which emphasized three core insights from behavioral science, namely that people think automatically, think socially and think using mental models.

Read the complete article.

April 4, 2016 – Handwashing Think Tank

April 4, 2016 – Handwashing Think Tank – Moving from Evidence to Action: Integration, Settings, and Scale handwashingthinktank

The facts about handwashing are clear. It prevents illness–from the commonplace such as influenza, diarrhea, and pneumonia–to the rare, yet deadly–such as Ebola. It’s benefits are far reaching as it impacts not only health, but also 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 isn’t prioritized from the personal level to the policy level.

Join the Global Public-Private Partnership for Handwashing, the London School of Hygiene and Tropical Medicine, and WaterAid as we learn how the evidence in handwashing integration, settings, and scale can be acted upon.

This event will feature brief, engaging presentations from experts in each of these areas. Attendees will also learn about the latest in handwashing research and have an opportunity to ask questions of the presenters. The event will be concluded with a cocktail reception.

WHEN – Tuesday, April 12, 2016 from 4:00 PM to 7:30 PM (BST)
WHERE – London School of Hygiene and Tropical Medicine – John Snow Lecture Theatre Main Keppel Street Building, London WC1E 7HT, United Kingdom


A Future Re-imagined: Urban Sanitation In India (Video)

Published on Mar 3, 2016
It’s not just about toilets. If we want to improve the quality of life in India, we’ve got to start paying attention to the sanitation value chain.

I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador

I get height with a little help from my friends: herd protection from sanitation on child growth in rural Ecuador. Intl Jnl Epidem, Mar 2016.

Authors: James A. Fuller, Eduardo Villamor, et al.

Background: Infectious disease interventions, such as vaccines and bed nets, have the potential to provide herd protection to non-recipients. Similarly, improved sanitation in one household may provide community-wide benefits if it reduces contamination in the shared environment. Sanitation at the household level is an important predictor of child growth, but less is known about the effect of sanitation coverage in the community.

Methods: From 2008 to 2013, we took repeated anthropometric measurements on 1314 children under 5 years of age in 24 rural Ecuadorian villages. Using mixed effects regression, we estimated the association between sanitation coverage in surrounding households and child growth.

Results: Sanitation coverage in the surrounding households was strongly associated with child height, as those with 100% coverage in their surroundings had a 67% lower prevalence of stunting [prevalence ratio (PR) 0.32, 95% CI 0.15-0.69] compared with those with 0% coverage. Children from households with improved sanitation had a lower prevalence of stunting (PR 0.86, 95% CI 0.64-1.15). When analysing height as a continuous outcome, the protective effect of sanitation coverage is manifested primarily among girls during the second year of life, the time at which growth faltering is most likely to occur.

Conclusions: Our study highlights that a household’s sanitation practices can provide herd protection to the overall community. Studies which fail to account for the positive externalities that sanitation provides will underestimate the overall protective effect. Future studies could seek to identify a threshold of sanitation coverage, similar to a herd immunity threshold, to provide coverage and compliance targets.