Behavior Change Strategy: Hygiene Promotion Guidelines for Bangladesh

bc strategy_bangladesh

To see improvements in health, social, and economic well‐being of families in the project districts in Southwest Bangladesh, the WASHplus activity works towards three objectives:

Objective 1: Improved access to safe drinking water, improved sanitation, and hygiene practices of poor and marginalized people in the targeted upazilas (subdistricts)

Objective 2: Build community and local government capacity to operate and
maintain facilities, and demand increased allocation of funds to ensure sustainability and impact

Objective 3: Strengthen the evidence base and programming guidance for
coordinated WASH‐nutrition programming in Bangladesh

While the need for improved water and sanitation access is clear, there is consensus that no
health or other development objectives can be achieved without the consistent and correct
practice of a suite of water, sanitation, and hygiene (WASH) behaviors including:

  • Safe and hygienic disposal of feces, including infant feces
  • Consistent and correct handwashing at critical junctures, particularly after
    defecation and before food preparation and feeding/eating
  • Safe handling and storage of household water
  • Menstrual hygiene management (MHM)

WASHplus is managed by FHI 360 and implemented in southwest Bangladesh through an agreement with WaterAid, who in turn have engaged local partner organizations (PNGOs) to implement in their respective upazilas or subdistricts. To guide the systematic and theory‐based activities of the PGNOs, WASHplus has developed these hygiene promotion guidelines for its partner NGOs to coordinate its approach in the field. In addition, capacity‐building and on‐going support to NGOs is offered to support improved WASH practice and ultimate achievement of target goals

Mark your calendars! May 21 #Menstrual Hygiene Twitterchat!

May 21 #MenstrualHygiene Twitter Chat

When: 21st May, 2015, 4 PM CET, 3 PM GMT, 10 AM EST, 7:30 PM IST

Hosted by:

@WASHUnited@WASHAdvocates, @WASHPlusInfo@KachraProject



Themes to be discussed:

  • Men in menstruation!
  • Policy advocacy around the world!
  • Menstrual waste & disposal!

Tweets to promote the chat:

  • If #MenstruationMatters to you, don’t miss the official #MenstrualHygiene Day Twitterchat on May 21 at 3PM GMT / 10AM EST / 7:30PM IST!
  • Join us & help break the silence around periods! Engage in the #MenstrualHygiene Twitterchat on May 21 at 3PM GMT / 10AM EST / 7:30PM IST!
  • If you’re a man, put the ‘MEN’ in menstruation & show your support for May 28 #MenstrualHygiene Day! Break the taboo! 

Small Doable Actions: Simple Steps That People Can Take to Improve WASH

Small doable actions are simple steps that people can take to improve WASH in their communities!

WASHplus Presents at USAID Mini-University 2015


WASHplus collaborated with USAID counterparts on three presentations at the Global Health Mini-University in March, with topics that included: 1) Gauging Consumer Preferences on Improved Cookstoves in Bangladesh, 2) Food Hygiene and Child Growth, and 3) Infant Feces Disposal.

Lessons From Zaragoza: Indicators, Integration, And Human Rights For Hygiene Post-2015

Woodburn_Hanna_2014This post, authored by Hanna Woodburn, has been reblogged from the Global Public-Private Partnership for Handwashing (PPPHW) website.


We are only a few weeks into 2015, but the Global Public-Private Partnership for Handwashing and other actors within the international development community have been anticipating this landmark year for quite some time. Later this year, the Member States of the United Nations will agree upon a new set of global, Sustainable Development Goals (SDGs) to replace the expiring Millennium Development Goals. To learn, collaborate, and strategize, the UN-Water organization convened key water, sanitation, and hygiene (WASH) sector actors in Zaragoza, Spain. The gathered experts, including the PPPHW, attended and participated in discussions around what tools and challenges face implementation of the proposed SDG for water (to view this goal, please see Goal 6 on page 12 of this document).

At this conference we learned about the role of various stakeholder groups, such as business, governments, civil society, and academia, in addressing the challenges of implementing a water SDG. We advocated for hygiene where it was absent, and came away with a new appreciation for the role that integration will play in driving forward progress on WASH in the post-2015 era.

As we look toward the remaining months of 2015 and what needs to be accomplished in terms of advocating for a comprehensive WASH goal, complete with targets and indicators for hygiene, it is clear that there are specific areas where the PPPHW and hygiene supporters can be engaged.

First, indicators will be the way forward in advocacy and ensuring that all components of WASH receive their due recognition within the SDGs. Indicators will need to be measurable, actionable, and ambitious. Without an indicator for hygiene we will not know the progress made on this crucial public health intervention.

Second, at the planning, stakeholder, and programmatic levels, integration will become increasingly important to address the myriad and interrelated challenges facing global health and development. WASH does not exist in a silo. The benefits from good hygiene services and behaviors, for example, range from improving health and nutrition to reducing inequities and improving school attendance. As such, broad collaboration will help ensure that the benefits from WASH are fully realized.

Finally, but not least, the human rights approach toward water and sanitation (articulated here), will continue to be used to frame the importance of access to these life-saving services. The key elements of such an approach are equality and nondiscrimination; participation and inclusion; and accountability and the rule of law. Hygiene is, and should be, covered under the umbrella of the human rights approach, but we need to make this association clearer.

We know that WASH is going to be essential to making progress on the SDGs, that there are tools that can help achieve the proposed water goal, but we also know that there is much work to be done in the meantime, particularly around ensuring that hygiene does not fall off the agenda. The PPPHW is committed to continued advocacy around these efforts, and we hope you will join us. Sign up for our email list, learn more about the conference here, and learn what goals, targets, and indicators the WASH sector are supporting here. The challenges are large, but not insurmountable. Overcoming them will both save lives, and ensure a healthier, more productive world Post-2015. Together we can help make this vision become a reality.

About the Global Public Public-Private Partnership for Handwashing: The Global Public-Private Partnership is a coalition of international stakeholders that aims to give families, schools, and communities in developing countries the power to prevent diarrhea and respiratory infections by supporting the universal promotion and practice of proper handwashing with soap at critical times.

WASH-Friendly Schools Guide


WASHplus’ SPLASH project in Zambia recently published a WASH-Friendly training guide geared toward educators, government officials, and communities that are interested in incorporating improved sanitation access, clean drinking water, and hand washing stations and materials to its students and teachers along with a complementary WASH curriculum and MHM. Though geared to the Zambian school context, much of the material is applicable to any low-resource school setting. Read the guide here.

Good Handwashing Key to a Healthy Holiday Season

by The Global Public-Private Partnership for Handwashing (PPPHW)

WASHINGTON, D.C. – December 17, 2014. The U.S. Centers for Disease Control and Prevention recently warned that this year’s flu season might be particularly severe, and some states are already reporting spikes in influenza. With the holidays also in full swing, the Global Public-Private Partnership for Handwashing (PPPHW) and the American Cleaning Institute are taking this opportunity to remind the public about a simple, affordable way to promote health this holiday season and throughout the year: handwashing with soap.

According to Dr. Layla McCay, Secretariat Director for the PPPHW, “Handwashing with soap can protect us from a wide range of illnesses by preventing the spread of germs, including the influenza virus. Washing our hands with soap helps us all fight influenza and stay healthy.”

Nancy Bock, Senior Vice President, Education at the American Cleaning Institute adds that “Families are concerned about staying healthy during the holiday season. Handwashing is especially vital during this busy time of the year with shopping and social events, many of which include food. Our message is simple: Frequent handwashing is one easy way to help prevent the spread of germs.”

To wash hands properly, wet hands with clean, running water (warm or cold) and apply soap, either in bar or liquid form. Rub hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails. Do this away from running water, so the lather isn’t washed away. Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice. Rinse your hands well under running water. Dry your hands using a clean towel or air dry them.

The critical times for handwashing are after using the bathroom or changing a diaper and before contact with food, but it is also advisable to wash hands after blowing your nose, coughing, or sneezing. You should also wash your hands more frequently when you or someone in your home is sick and anytime your hands are visibly dirty.

As you exchange gifts this year make sure you aren’t also exchanging germs. Wash your hands with soap thoroughly and regularly.

About the Global Public Public-Private Partnership for Handwashing

The Global Public-Private Partnership aims to give families, schools, and communities in developing countries the power to prevent diarrhea and respiratory infections by supporting the universal promotion and practice of proper handwashing with soap at critical times.

About the American Cleaning Institute

The American Cleaning Institute® (ACI) is the Home of the U.S. Cleaning Products Industry™ and represents the $30 billion U.S. cleaning products market. ACI members include the formulators of soaps, detergents, and general cleaning products used in household, commercial, industrial and institutional settings; companies that supply ingredients and finished packaging for these products; and oleochemical producers. ACI ( and its members are dedicated to improving the health and quality of life of consumers through sustainable cleaning products and practices.

Design, Delivery, and Monitoring & Evaluation for Handwashing With Soap Programs

This course is designed by the Center for Global Safe Water at Emory University and the Global Public-Private Partnership for Handwashing (PPPHW) for program implementers, policy makers, teachers, and M&E specialists on the design, delivery and monitoring and evaluation of hand washing with soap (HWWS) programs. The course is geared towards those interested in promoting handwashing with soap among populations in the Global South.

This course will cover concepts including:

  • Community- and school-based HW promotion
  • Marketing and social marketing
  • Private sector approaches
  • Government, NGO and community led-approaches
  • Approaches for low- and middle-income settings

At the end of this course, participants will:

1. Understand the current state of knowledge for HWWS
2. Identify current approaches to hygiene and HWWS promotion
3. Utilize a specific behavioral framework to design a program for HWWS
4. Develop a HWWS behavior change strategy
5. Know the steps of developing a HWWS program
6. Become familiar with the basic tools to monitor and evaluate HWWWS program

The course includes two modules that will help participants learn practical guidance on how to design and implement HWWS behavior change programs that target marginalized groups in communities, schools, health centers and other institutions.

Module 1 covers:

  • The state of knowledge and evidence base for HWWS
  • The key times for to promote HWWS
  • The technologies used for HWWS
  • How HWWS is promoted by different stakeholders
  • Examples of HWWS programs, including current approaches and behavioral frameworks

Module 2 covers:

  • Developing a HWWS behavior change strategy
  • Planning a HWWS program from buy-in to concept and execution
  • Monitoring and evaluating a HWWS program to ensure program sustainability and learning

Click here to download the course curriculum, module 1, module 2and supplemental readings.

Hand Washing and the Science of Habit: A Webinar

Hand Washing and the Science of Habit: A Webinar

On December 4, WASHplus and the global Public Private Partnership for Handwashing (PPPHW) co-hosted a webinar with David Neal, Ph.D., from Catalyst Behavior Sciences and the University of Miami. Dr. Neal is a social psychologist specializing in behavior change and the advanced measurement of human decision making.  He discussed the usefulness of habit theory for health programming targeting households. Although he emphasized ways to apply the basic science of habit and behavior change to real world health interventions and program delivery, with a focus on behavior change for handwashing with soap, his ideas are relevant to anyone working on behavior change activities. The webinar was well attended by nearly 200 participants from 15 countries with more than 1,000 subsequent views. The countries included: Bhutan, Cambodia, Canada, India, Nepal, Pakistan, the Philippines, Uzbekistan, and Zambia. A recording of the webinar and slides are available here.  

Learning by Observation: Children and Hand Washing in Periurban Cotonou

armand picby Armand A. AGUIDI, WASHplus Coordinator in Benin

Although they are important beneficiaries of hand washing awareness raising campaigns, children are not directly targeted by community mobilizers unless the activities take place at schools. Household-based activities target primarily, and sometimes exclusively, mothers or children’s  caretakers. In fact when children attend these awareness-raising activities geared toward their parents, they are not always welcome. The organizers, and also the parents, don’t hesitate to chase away these “troublemakers” so attention can be focused on the adults.

However, my observation of community mobilization activities in periurban districts of Cotonou calls attention to the missed opportunities of this adult-centered approach.

Setting up a Hand Washing Device in Enagnon

During a tippy tap training organized at a youth center in Enagnon, one of the WASHplus intervention neighborhoods of Cotonou, two things captured the participant’s attention: demonstration of the various hand washing devices and the group of children gathered together to follow the activities. The gathering was particularly large during the fixed hand washing device testing, and these children attentively followed the way in which the trainees washed their hands. They were very disappointed when, at the end of the exercise, the device was moved from the doorway to the interior of the training center, preventing any access to it. The situation changed when one of the participants asked that the hand washing device be displayed again by the doorway and left within the children’s reach. We then observed the children moving automatically as a group toward the hand washing device.


We may be tempted to attribute part of the children’s interest to curiosity, but we must nevertheless also recognize that this attitude demonstrates the potential for flexibility, maneuverability, and willingness of children, all important elements in behavior change activities.

Later in the day the same afflux of children was observed watching a hand washing with soap demonstration for mothers. Although they lacked permission from the hygiene promoters to participate in the demonstration, these children attentively followed the actions and gestures of the adults from start to finish. Imagine our surprise when we passed by the same house a few minutes later and saw the children gathered around the water giving each other a lesson in washing their hands with water and soap. They were inspired by the advice given to their parents a few minutes earlier. 


Children Imitate and Learn

We observed that children gather around each time hygiene promoters visit households to present information. Often the adults chase them away or prevent them from having access to the tools utilized. But driven by curiosity, they resist in many cases and find ways to overcome their exclusion. They attentively observe the adults’ actions, they memorize and imitate them, and instruct themselves at the same time as the adults. Therefore, without knowing it, and also without meaning to, the hygiene promoters train both parents and children, killing two birds with one stone. The impact is thus amplified and increases in value.


These comments on the hygiene promoters relate primarily to the fact that no room is made for children within household behavior change activities. School seems to be the only environment for children to learn about these activities. In reality, children are also available when they are at home and must be included in, or at a minimum tolerated during, sessions held with their parents. Children should, from now, be considered as direct beneficiaries of household awareness-raising activities, and be invited to the household hand washing sessions in the same way as their parents. For this learning by observation, no particular effort is needed except to hold the sessions in places that facilitate children’s access.

In educational psychology, we say that learning by observation and imitation necessitate the presence of a model (in this case, the hygiene promoter) who demonstrates a behavior, and a trainee (in this case, the child) who observes. The model doesn’t necessarily have the intention of teaching; it is the trainee who decides to learn from the model.

Children Look for Models

In every society, human beings need a course of action, a model to follow, people to refer to. This need for a model is even more pronounced in children.

Where hand washing ins concerned, children also look to their parents as models. Parents must tell themselves that children want to see their parents adopt the promoted behaviors not just hear about them. When hand washing becomes a regular habit of the parents, the behavior will be reproduced by the children with significant benefits to everyone’s well-being.


Children are Information Carriers and Awareness Raisers

Beyond the fact that children reproduce their parents’ gestures and in this way ensure the adoption of desired behaviors, children can also serve as information carriers to their families and with their friends. It is not rare to see children correcting their parents. In objecting, “Oh mom, you told us that we must always wash our hands before eating, but you didn’t do it,” the child points out the parent’s responsibility to model correct behavior and reminds her that her lesson was well absorbed by her child. Didn’t the poet say, “Each child that we teach is a person we win?”

It follows that children must not be expelled or excluded from household awareness-raising sessions. They must not be barred because in raising awareness with their mothers, we target them indirectly. Hygiene promoters will benefit from accepting them and letting them express themselves.