46361 The Global Public-Private Partnership to Promote Handwashing with Soap Handwashing with soap could save a million lives Diarrhoea kills two million children every year. Human excreta is the source of most diarrhoeal pathogens and probably the most important moments at which hands should be washed with soap are after contact with human excreta, and before handling food. A recent review of all the available evidence suggests that handwashing with soap could reduce diarrhoea incidence by 42-46% and save at least one million lives1. The Global Public-Private Partnership to Promote Handwashing Handwashing with soap may be an old idea, but it is far from universally practiced. Combining the expertise and resources of the soap industry with the facilities and resources of governments to promote handwashing with soap is one obvious solution. While governments and development agencies want to combat disease and poverty, industry is interested in expanding its market. The World Bank and the Water and Sanitation Program (WSP), the London School of Hygiene and Tropical Medicine (LSHTM), the Academy for Educational Development (AED) and the private sector, in collaboration with USAID, UNICEF, and the Bank-Netherlands Water Partnership2 are developing a global initiative aimed at promoting the use of handwashing with soap in developing countries. Work has started in Ghana and India. The results are being monitored and the lessons documented and disseminated. The work is now expanding to four other countries, Senegal, Peru, China and Nepal. 1 X The Central American Initiative BO `Lavo mis manos por salud' In 1996-1999 the USAID-supported Central American Handwashing Initiative3 showed that soap companies are capable and willing partners for health promotion activities. Four private soap companies launched handwashing campaigns in three countries (Guatemala, Costa Rica, and El Salvador) in collaboration with the public sector. | Objective | - 30% increase in hygienic handwashing To improve handwashing behavior in order to reduce behavior in mothers. diarrhoeal diseases among children under five. - An estimated 300,000 fewer cases of diarrhoea a year in poor children under five in | Communication Program | Guatemala. · Leverage of resources · Behavioral research to determine baseline and consumers' handwashing habits · Sustained involvement of the private sector in social programs · Mass media coverage (both educational and commercial) | Partners | · Rural distribution and promotional activities by USAID, Colgate-Palmolive-Guatemala, La Popular soap companies S.A.-Guatemala, Unisola/Unilever-El Salvador, Punto · Community activities through the public sector, Rojo-Costa Rica, Ministries of Health and Education, NGOs and foundations (schools, municipal media companies, UNICEF, NGOs, Foundations... and health center programs) · Monitoring and evaluation | Contact | Camille Saadé Academy for Educational | Key Results | Development csaade@aed.org · Improved handwashing behavior and Lisa Nichols Environmental Health Project decreased incidence of diarrhoeal diseases nicholsls@ehproject.org Objectives of the Initiative Key results of first phase activities (February 2001 to June 2002) · To reduce the incidence of diarrhoeal diseases in At the global level, the team has: poor communities through Public-Private · set up an international advisory group; Partnerships (PPPs) promoting handwashing with · published the Central America Handwashing soap. experience; · To implement large scale handwashing · carried out a study of the experience of PPPs in interventions and use lessons to promote the the health sector; approach at global level. · studied the world market for soap; The idea is to get private industry and the public · worked with the three biggest multinational soap sector to work together with other partners to develop companies on perspectives for expansion to new programs to promote handwashing. The non- countries; and branded programs are open to all interested parties, · developed a project proposal that was approved both public and private, targeting those most at risk by the Bank-Netherlands Water Partnership as a (mothers, children, the poor) across the whole flagship project. population. Based on detailed consumer studies, After a year in the field, the partners have: these programs reach out to target audiences through · established bases in India and Ghana; mass media, direct consumer contact and · built local partnerships with industry associations, government channels of communication. The industrial and small-scale manufacturers, programs also gather knowledge through action Ministries, external support agencies (ESAs) research and detailed monitoring and evaluation. and NGOs; · set up national or state-level steering committees 2 X and made concerted advocacy efforts; A win-win public-private BO · designed, commissioned, and assisted in the partnership for handwashing execution of studies of soap consumption and the 1 Promoting a vital behavior and a product soap market in Ghana and Kerala, India; and Handwashing with soap is equivalent to a `do-it-yourself · designed communications programs to promote vaccine' and could be promoted as widely and effectively handwashing across Ghana. Government and as vaccinations. Washing hands with soap after contact external support agencies have made funding with fecal material (after using the toilet or after cleaning commitments, whilst the private sector is up a child) prevents the transmission of the bacteria, providing technical and managerial skills and viruses, intestinal parasites, and protozoa that cause resources. diarrhoeal diseases. However, changing the habits of a lifetime is not so easy and requires a huge and concerted Second phase activities include effort. The task will be made easier if the private sector (June 2002 to July 2003) can offer affordable products specifically for handwashing. · Support implementation of the handwashing campaign in Ghana 2 The gaps to address · Improve methodology for consumer research We have learnt from past experience that: · Establish baseline and monitoring and evaluation · short-lived hygiene education programs, mostly in the indicators public sector, have had little impact; · Expand program to more countries: Senegal, · covering large populations cost-effectively is very Peru, Nepal and China difficult through traditional participatory methods, · Follow-up, monitor and assess campaigns even if these may be effective at improving hygiene on a small scale; and · Research on cost-effectiveness of handwashing · soap is widely available, even in poor households, interventions but is not generally used for handwashing at critical · Promotion of global experience sharing and times. continued advocacy · Finalize a monitoring and evaluation system and 3 Combining resources to reach test it in Ghana the poorest groups Finding new customers and encouraging more · Conduct a cost-effectiveness study handwashing requires an in-depth understanding of the · Share experience with other organizations target consumer needs in order to find effective ways of involved in handwashing promotion and marketing the appropriate products and behaviors. Social preventative health marketing style approaches based on adequate formative Steps followed to develop a handwashing research into risk behavior, context, and motivation are initiative beginning to show good results. The skills and resources 1 Assessment of the incidence and costs of of both public and private sector are needed if handwashing is to be promoted successfully on a wide diarrhoea and likely benefits of a reduction of scale. diarrhoeal diseases in children. The public-private partnership dedicated to handwashing 2 Mapping the existing hygiene education pools resources and risk and provide added value over programs. what each party could achieve alone. There are obvious 3 Building partnerships between public and private benefits to both sides: actors involved in public health, water supply and · For the public agencies and governments: To hygiene products. achieve public health goals and learn from soap 4 Establishment of advisory and implementation manufacturers' expertise in crafting effective task force and vigorous communication to all communication programs. parties involved. · For the industry: To learn more about consumer 5 Analysis of the market for handwashing soap and demands and expand the consumer base to include consumer habits. poorer households 6 Design of communications programs to support · For both sectors: To understand and change behaviors a large scale handwashing promotion program. for better health. To make the campaigns sustainable over the long run, without making infrastructure 7 Fundraising through partners. investments, through creating synergies with existing 8 Implementation of communication campaign. initiatives in water supply and sanitation. 9 Monitoring and evaluation of results and impact. 3 X The PPP in Ghana BO GHANA: `Clean hands, healthy life' | Objective | To increase handwashing with soap by 25% among mothers and caregivers of children and by 50% among school children. | Communication Program | · Consumer and soap market knowledge · Target all 2.5 million women with children under five · Reach 19,000 primary and secondary schools in 110 districts and 1,800 health centers Ministry of Local Government and Rural Development, · Integrated mass media and direct Unilever, PZ-Cussons, Getrade, Association of Ghanaian consumer contact (DCC) program Industries, others. · Public relations program in support of | Contacts | handwashing · Detailed monitoring and evaluation (M&E) · Nana A. Garbrah-Aidoo, CWSA handwash@ghana.com | Partners | · Kofi Asamoah, CWSA Community Water and Sanitation Agency cwsa@ghana.com (CWSA), Ministry of Works and Housing Ministry of Health, Ministry of Education, · Arthur Swatson, World Bank Ministry of Women and Children's affairs, aswatson@worldbank.org How can we support you? Academy for Educational Development The Global PPP Handwashing Initiative is a learning- www.aed.org as-you-go process. Visit our website at http:// Camille Saadé: csaade@aed.org www.globalhandwashing.org for materials on: Centers for Disease Control and Prevention Steve Luby: sluby@cdc.gov · Publications and other learning products · A newsletter and up-dates on the initiative Colgate-Palmolive 2003 www.colgate.com · Links to other handwashing initiatives and partners Diana Grina: diana_grina@colpal.com March Or contact us at any of the following addresses: Procter & Gamble www.pg.com Ltd. World Bank / Bank-Netherlands Water Partnership Tim Long: long.tj@pg.com Pvt. www.worldbank.org/watsan/bnwp Hindustan Lever Jennifer Sara: jsara@worldbank.org www.hll.com Services Esther Monier-Illouz: emonierillouz@worldbank.org Yuri Jain: yuri.jain@unilever.com Press Water and Sanitation Program PS UNICEF www.wsp.org at: www.unicef.org Parameswaran Iyer: piyer@worldbank.org Lizette Burgers: lburgers@unicef.org Printed · London School of Hygiene and Tropical Medicine USAID www.lshtm.ac.uk www.usaid.gov Valerie Curtis: val.curtis@lshtm.ac.uk John Borrazzo: Jborazzo@usaid.gov Associates Design 1Curtis V., Cairncross S, "Effect of Washing Hands with Soap on Diarrhoea Risk in the Community: a Systematic Review". Green 2The Bank-Netherlands Water Partnership is a facility that enhances World Bank operations to increase delivery of water supply and sanitation services to the poor (for more information see http://www.worldbank.org/watsan/bnwp). by: 3Implemented by BASICS (Basic Support for Institutionalizing Child Survival) and the Environmental Health Project (EHP). See publication, "The Story of a Successful Public-Private Partnership in Central America: Handwashing for Diarrheal Disease Prevention" and the mini-cd (February 2002). Created