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Wash’Em: Designing better handwashing behaviour change programmes

October 15, 2019

By: Sian White, London School of Hygiene and Tropical Medicine

Photo Credit: Wash’em/Astrid Hasund Thorseth

Wash’Em is a process for designing hygiene behaviour change programmes in humanitarian crises.

Through several years of research with crisis-affected populations we realised that current approaches hygiene promotion activities are not actually changing behaviour. Typical approaches involve educating populations about disease transmission and distributing soap. However, crisis-affected populations told us that teaching them about handwashing was a bit condescending – after all it’s not that they were stupid but rather their world had just fallen apart so it was hard to make handwashing with soap a priority.

We have spoken to lots of humanitarians over the last few years too. We realised they are incredibly passionate people, who work hard and want to do better hygiene programming. But it’s difficult with limited resources, limited time and the general stress of an emergency – the temptation is to repeat whatever you have done in the past.

The Wash’Em process is designed to work within the constraints of the humanitarian system. It provides a way of rapidly learning about the behaviours of crisis affected populations and helps humanitarians to use these insights to develop a context-adapted innovative programme – all in just one week.

The four steps of the Wash’Em process:


Photo Credit: Wash’Em

We released the Wash’Em Rapid Assessment tools a year ago. Since then we have supported 45 organisations to learn about the tools and use them to gather data and design hygiene programmes in 27 emergencies all around the world.

Lately we have been testing out the initial version of the Wash’Em decision making software. Designing this has been a mammoth task! It includes 80 different handwashing activities, more than 1000 rules which influence how it makes recommendations and 20,000 lines of software code! The set of activities that get recommended are not about teaching people about disease. They are designed to make handwashing infrastructure convenient and desirable, to motivate people to wash their hands by making it seem aspirational and to reward good behaviour so that handwashing with soap becomes the new norm. An example of a simple activity to demonstrate the power of soap can be found here.

Some of the Wash’Em activities also directly address this year’s Global Handwashing Day Theme and are designed to help your community realise that handwashing is not always easy for everyone. Here is an example of an accessibility activity:

How: Organise a community event


  • Set up a handwashing facility that is similar to what people have in their homes.
  • Ask for four volunteers from the audience.
  • Get a male volunteer from the audience to wear a heavy backpack on his chest to simulate what it is like to be pregnant. Now ask him to wash his hands at the handwashing facility.
  • Ask an adult to try using the handwashing facility while kneeling down so they can imagine what it is like from a child’s height.
  • Ask another volunteer to be blindfolded to imagine what it is like to be blind – is it possible for them to use the handwashing facility now?
  • Give the fourth volunteer some crutches and ask them to also try using the handwashing facility.
  • Ask people in the community to brainstorm low-cost ways to make their facilities more accessible for everyone.

Why: For most of us handwashing with soap is easy. Sometimes you need to make people ‘step into someone else’s shoes’ for a moment so that they can appreciate the challenges they face. The discussion immediately after will help your population translate this new realisation into action that can lead to greater access for all.

Why not try out this low-cost idea for Global Handwashing Day this year and share your feedback and photos with us via the hashtags #WashEm #CleanHandsForAll

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Wash’Em is a collaboration between LSHTM, ACF and CAWST. Wash’Em was made possible by the generous support of the American people through the United States Agency for International Development (USAID).



Category: Community Forum

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