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                          enGender Impact: The World Bank’s Gender Impact Evaluation Database



        Handwashing Behavior Change at Scale Evidence from a Randomized Evaluation in Vietnam

 Author(s)    Claire Chase and Quy-Toan Do
  Contact     cchase@worldbank.org

  Country     Vietnam
Organizing
              Health
 Theme
   Status     Completed
Intervention
             Information Intervention, handwashing
  Category
  Sector      Water
              Handwashing with soap, which has been shown to reduce diarrhea in young children by as much as 48 percent, is
              frequently mentioned as one of the most effective and inexpensive ways to save children’s lives. Yet rates of handwashing
              remain very low throughout the world. Handwashing with soap campaigns are de rigueur in developing countries, but
              little is known about their effectiveness. Few have been rigorously evaluated, and none on a large-scale. This paper
              evaluates a large-scale handwashing campaign in three provinces of Vietnam in 2010. Exposure to the campaign resulted
 Abstract     in a slight increase in the availability of handwashing materials in the household, and caregivers in the treatment group
              were more likely to report washing hands at some of the times emphasized by the campaign. However, observed
              handwashing with soap at these times is low, and there isn’t any difference between the treatment and control groups. As
              a result, no impact on health or productivity is found. These results suggest that even under seemingly optimal conditions,
              where knowledge and access to soap and water are not main constraints, behavior change campaigns that take place on a
              large scale face tradeoffs in terms of intensity and effectiveness.
 Gender
              Gender Informed Analysis
Connection
 Gender
              Gender disaggregated hand washing
Outcomes
 IE Design    Clustered Randomized Control Trial (Clustered at community level)
             There are two components to the intervention. Component 1 was a mass media campaign that featured 30 and 15 second
             television spots on popular national and regional TV channels. The second component is the interpersonal
Intervention communication activities. The Vietnam Women's Union trained over 14,000 village health workers, teachers, and Union
             members on how to promote group and household level activities that reinforced handwashing behavior. The trainers met
             with women to provide instructions of proper handwashing behavior.
Intervention
             The intervention lasted for 9 months mostly in 2010
   Period
  Sample     The study examined 210 communes from 15 districts in 3 provinces were selected to participate. There was a sample size
 population of 3150 households, corresponding to 15 households per commune.
Comparison The treatment community received the mass media campaign and the interpersonal communication activities. The control
 conditions received just the mass media campaign.
  Unit of
             Household level
  analysis
 Evaluation
             December 2009 to March 2011
   Period


             Last updated: 14 August 2013                                                                      1
                            enGender Impact: The World Bank’s Gender Impact Evaluation Database


                The program did not have an impact on handwashing with soap behavior. Knowledge about the correct way to wash was
                high at baseline, and some areas of knowledge improved, but it did not have an impact on the already high access to soap
  Results
                within households and modest effects on the self-reported handwashing behavior of mothers. Observed handwashing
                behaviors remained very low; mostly caregivers wash their hands with water only.
                A pure control group was not part of the study design thus it is impossible to detect the impact of the mass media
  Primary
                campaign. Project implementation happened at large-scale so there was little direct control over the implementation of the
   study
                intervention. It is possible that mothers did not attend the meetings. The study may have been contaminated by other
limitations
                health projects in the area.
 Funding
                Bill and Melinda Gates Foundation
  Source
                Chase, C., & Do, Q. T. (2012). Handwashing behavior change at scale: evidence from a randomized evaluation in
Reference(s)
                Vietnam. World Bank Policy Research Working Paper, (6207).
  Link to
  Studies       https://openknowledge.worldbank.org/handle/10986/12056
 Microdata
                http://microdata.worldbank.org/index.php/catalog/1242http://microdata.worldbank.org/index.php/catalog/1242




               Last updated: 14 August 2013                                                                     2