December 7, 2020

On Thursday, December 3, 2020, the Global Handwashing Partnership hosted a webinar entitled “Integrating Handwashing with Related Programming” as part of its ongoing Handwashing Thursday Series. The series aims to amplify the launch of the Partnership’s most recent publication: The Handwashing Handbook. The handbook, which launched on Global Handwashing Day 2020, serves as an all-in-one resource for handwashing and hand hygiene programming.

The webinar focused on the fourth chapter of the handbook: Improving Handwashing in Specific Contexts. Specifically, presentations focused on mainstreaming handwashing behavior change into other programs. Handwashing integration is needed to achieve optimal results with impacts across the Sustainable Development agenda.

Handwashing in Fragile and Conflict-Affected Settings

The session started with a presentation from Mr. Tom Heath, a WASH Technical Advisor for Action Against Hunger. His presentation focused on handwashing in fragile and conflict-affected settings. Fragile and conflict-affected settings can provide the ideal environment for the spread of pathogens. In fact, during conflicts, children are 20 times more likely to die from diarrheal disease than violence. This highlights the need for proper water, sanitation, and hygiene access and practice in these settings.

In his presentation, Mr. Heath discusses ways to encourage handwashing in the emergency context, noting different constraints such as lower capacity, less time, and fewer resources to implement programs. He also mentioned that people in crisis may have different determinants affecting their handwashing behavior. This requires adapting our approaches. Finally, he provides key examples for successful approaches, including the Mum’s Magic Hands Program, as well as key tools and solutions like the SuperTowel and Wash’Em.

Handwashing and Immunizations

Esha Sheth, a Senior Brand Manager for Unilever-Lifebuoy, then discussed integrating handwashing with immunization programs. Specifically, she highlighted Unilever’s partnership with Gavi, the Vaccine Alliance, to improve demand generation for complete immunization and handwashing with soap. In her presentation, she discussed the partnership and their collaborative program to address handwashing, immunization, and other key behaviors. The partnership developed a program called ‘Safal Shuruaat’ translated as ‘Successful Beginnings,’ which focuses on empowering mothers and fathers to adopt key behaviors and make a difference in their child’s future. While interactions focused on handwashing and immunization primarily, other aspects such as nutrition, enrichment activities, and interspousal communication were also addressed through the program.

The partners used a multi-modal approach through in-person, digital, and social channels to drive handwashing and immunization behaviors. Message reinforcement also came through various touch points to trigger different motivations and behaviors, enhancing self-efficacy and re-framing social norms. Ms. Sheth concludes her presentation by presenting challenges and the way forward. While the program has been successful in engaging with the ministry, it will be important to establish joint ownership to ensure the effects are sustainable.

Handwashing and Neglected Tropical Diseases

Ms. Dorin Turgeman, Head of Operations at NALA Foundation, highlighted the importance of hygiene in NTDs program efforts. As an organization, NALA strives to eradicate NTDs and other diseases of poverty related to hygiene and sanitation. Through their programming, they focus on a holistic intervention model that addresses all elements of disease elimination, including complementing mass drug administration with behavior change and promotion of water, sanitation, and hygiene (WASH) improvements in the community and school levels.

Because NTDs are behavioral diseases, many are preventable with proper hand hygiene behaviors. NALA focuses on creating hygiene behavior change by operating interactive health education programs that motivate the target population by addressing key determinants for handwashing behavior. Their programs engage emotional connections through games, relatable images and role-play. By integrating hygiene into their NTDs programming, they hope to accelerate disease elimination.

Handwashing and Nutrition and Early Childhood Development

Peter Hynes, Program Manager at World Vision and a member of the Clean, Fed & Nurtured Coalition,  ended the series of presentations by providing an example of handwashing integration with nutrition and early childhood development. The Clean, Fed & Nurtured Coalition focuses on the integration of the following sectors: WASH (clean), nutrition (fed), and early childhood development (nurtured). Through its coordinated focus, it strives to shift the ways in which we support child growth and development.

Mr. Hynes provides an example of a program implemented by World Vision and the Manoff group in Uganda. Key handwashing messages were incorporated into pre- and post-natal care visits as part of a larger maternal, newborn, and child health project. He notes that when integrating handwashing into other programs, it is important to focus on the child-centric nature of handwashing, engaging internal champions as well as pointing to the evidence.

In his presentation, he also highlighted 10 practical steps to ensure integration, including:

• Start small. A small pilot, if done well, can showcase to staff the benefits of integration and help to raise enthusiasm for a bigger project.
• Utilize internal champions. Having a champion at the helm ensure energy and perseverance from the beginning.
• If sectoral expertise is not available within your organization, look for partnerships. Look to other organizations that have the experience where you are lacking.
• Focus on strengthening the evidence base. Include quantitative and qualitative research components that can demonstrate an integrated program has better health impacts than siloed programming.
• Connect to integrated government frameworks. Governments are creating integrated plans (integrated nutrition or integrated early childhood development) and it will be important to pitch your program in alignment with these plans.
• Make the linkages between health outcomes. Discussing interlinkages of health outcomes and the rationale behind a multi-sectoral approach can make individuals more invested.
• Frame integration around the needs of a child. Stressing the importance of integration for young children can help build internal commitment, which will help external engagement.
• Insist on face-to-face meetings between sectors. It is essential that sector experts discuss how to embark on a program to make it more integrated.
• Utilize gender empowerment and community mobilization as key cross-cutting themes. Gender empowerment and community mobilization both came up as key unifying themes in programs that had successful integration.
• View integration as a means for capacity building. It is important to build capacity and further investment among current staff members. This results in more excitement and willingness to stay at an organization longer because they view their company is investing in their growth.

Key Takeaways

Following the presentations, a moderated panel discussion presented the challenges and value-add of integration. Key takeaways from this webinar include:

• Handwashing has cross-cutting effects in many different contexts. It is important to understand how handwashing practice can be optimized and think through the value-add of integrating handwashing with related programs.
• Use a multi-faceted approach. Using a holistic approach can drive behavior change and ultimately habit formation.
• Start small. It is important to test an integrated program in terms of principles of scale to ensure the government can pick it up at the same level and with cost efficiency.
• Work with the community and local structures. This will ensure proper handover and stability by the community for any program.
• Share your successes and failures. Integration is a iterative. It is critical that you share what has worked and what has not so that others may learn and adapt future efforts.

Webinar slides are available here. The webinar recording is available below.

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