October 14, 2020

By: Sona Sharma and Armelle Sacher, Action Against Hunger

To promote hygienic behaviors, we must communicate and engage with communities across a variety of communication channels. In Uganda’s Kyangwali refugee settlement, Action Against Hunger’s social and behavior change efforts went beyond the simple dissemination of messages through multiple channels to also include specific tactics for enhanced engagement with communities. The efforts bore fruit, bringing about changes in handwashing behaviors.

Photo Credit: Sona Sharma, Action Against Hunger

Action Against Hunger, as a member of a project consortium supported by the European Union, aims to address immediate basic needs and increase resilience through an approach that puts people at its heart. Our efforts to improve access to clean water, safe sanitation, and good hygiene includes a variety of activites, including a ‘Cash for Latrine’ intervention and behavior change interventions to promote critical behaviors around handwashing, use of latrines, and safe disposal of child feces.

When the project began, just 43% of households in Kyangwali had handwashing facilities and only 32% of the household could list three critical moments for handwashing. Action Against Hunger conducted formative research to identify the main factors influencing hygiene behaviors in addition to the community’s preferred communication methods.

Based on our findings, we implemented a social and behavior change (SBC) strategy that included strategic engagement with communities through multiple platforms and channels, such as group sessions and home visits, community-based video shows and dialogues, drama shows, radio spots and talk shows, and rigorous follow up through hygiene promoters.

“The drama shows were very well done, and we learned that it is not good to use a latrine without a hand washing facility because the family members fell sick when they used the latrine and did not wash their hands after doing it.” – Caregiver for child under two years old

One unique aspect of this intervention was that every activity was planned in great detail to ensure it is connected with other activities for better recall, that there is two-way communication with communities and they are followed up to track behavior change. For example, a community-based participatory process was adopted, where community members, hygiene promoters, and local drama groups collaborated with professional actors and filmmakers to create and produce two video shows about handwashing and good hygiene. This tactic benefitted the video shows, since the audience related to known settings and were excited to see people they knew in the film. It also benefitted the drama shows as people recognized the actors from the film, thereby resulting in better engagement of the audiences.

“Videos taught us to use water and soap to wash hands when we are going to eat and that if we eat food without washing hands we shall get diseases as we saw on the video show” – Community Leader

The videos were screened in public venues and used to spark interactive discussion around hygiene. Every activity with the community members, whether a video show, a sensitization session or a drama show included interactions with people and ended with a request for commitments to adopt the promoted behaviors. Hygiene promoters then followed up on these commitments during their home visits. People from the community also participated in radio talk shows, by serving on panels or calling in to ask questions and clarify doubts.

Communities were not just passive recipients of messages, but active participants in every SBC activity. The results, within a short intervention time, reveal the potential of such a participatory approach.

In March 2020, a qualitative assessment of the effectiveness of the SBC component reported that project beneficiaries had very good knowledge of the five hygiene behaviors promoted through the intervention. The most prominent motivating factors for adoption of handwashing were the facts that handwashing prevents diseases such as cholera and Ebola and that families, especially those with young children, would be healthier with regular handwashing.

“Hand washing is easy because of the installation of the tippy tap and safe disposal of feces because I have a latrine.” – Mother of child under 5 years old

Photo Credit: Sona Sharma, Action Against Hunger

The video and radio shows had the ability to reach men, who are often left out from hygiene promotion activities. Additionally, many households had equipped themselves with simple home handwashing stations (tippy taps) and were regularly using them. Mothers, fathers, and other caregivers reported that handwashing was easy to practice, but that using soap was still a challenge as many people couldn’t afford it and the practice of handwashing before cooking was still not widely used. Finally, Action Against Hunger produced and shared guidance on radio programming, which continues to be used by partners to engage communities from a distance during the COVID-19 pandemic.

“It’s the hands that do everything in the home, and also it’s the hands that bring everything to the mouth, so hand washing is very important” – Mother of child under two years old

Several recommendations were made to improve the interventions, such as using music during the drama show to make it more attractive for a Congolese audience in the refugee camp; providing nylon rope for tippy taps, as ordinary rope often broke; equipping community leaders with radios to increase audience coverage; giving promotors tablets and speakers to show the video during door-to-door activities; and advising community members on how to prevent termite damage to tippy taps.

Action Against Hunger made a conscious effort to plan and synchronize our SBC activities to maximize overall impact. Activities were rolled out strategically, focusing on one topic at a time with simultaneous capacity-strengthening among hygiene promoters. With access to quality technical SBC support, trainings, and a detailed facilitation manual, the implementation team had every support they needed too.

In these difficult times, we know that promoting handwashing with soap is a dire necessity. We hope that these valuable lessons from our SBC intervention will lead to large-scale changes in handwashing behaviors.

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