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Behaving clean: innovative approaches to hygiene promotion in Burkina Faso and Zimbabwe

Hygiene promotion is an important but notoriously difficult part of any water and sanitation programme. Experience in Burkina Faso and Zimbabwe show that understanding how people actually behave is the key to initiating change. Researchers from the London School of Hygiene and Tropical Medicine report on real and measurable change in hygiene behaviour, and identify ideas which could be applied on a larger scale.

Programme Saniya was designed as a hygiene promotion programme for Burkina Faso’s second city, Bobo-Dioulasso, and was carried out between August 1995 and July 1998. It uses ‘formative research’, a process of study in the community to find locally-specific answers to key programme design questions, such as the choice of target behaviours and audiences. For instance, on finding that mothers desired hygiene more for aesthetic than for health reasons, messages were built around issues of quality of life and respect that one gains from being hygienic. Effective communication channels were identified using focus groups and a questionnaire. Monitoring showed the programme showed to be effective in terms both of cost and of measurable behaviour change.

In Zimbabwe the NGO ZimAHEAD pioneered the concept of community health clubs, voluntary groups formed to improve family health in participating villages. From a small field study in 1994, the approach was expanded until in 2000 there were 350 clubs and over 20 000 beneficiaries. Members receive hygiene education and are encouraged to adopt new practices. A membership card and regular informative quizzes and other events help to create a sense of belonging and provide valuable monitoring information.

Research findings include:

Under Project Saniya, an estimated 8 638 cases of diarrhoea and 105 deaths were averted.
Savings under Project Saniya, calculated as medical costs and lost days of productive work were put at US$ 394 000 - more than the cost of the programme.
Project Saniya was judged affordable and could be widely replicated at a lower cost through savings in research input and start-up costs.
Under ZimAHEAD it is possible to estimate the cost per beneficiary in each district. One example showed the cost per person as US$ 0.52.
ZimAHEAD group members felt a strong sense of commitment to the clubs due to the social opportunities and intellectual stimulus they offer.
A research programme involving 1 125 respondents showed that club members achieved 79% positive change for 15 key hygiene indicators, compared to 38% achieved by non-club members.

Both projects approach hygiene promotion through first understanding and then changing behaviour. Effective programmes should address behaviour change systematically and focus on the required changes. Emerging information suggests that:

communities are not passive recipients of hygiene education: they must be treated as active partners and should be systematically consulted and involved
structured observation using clearly defined criteria give the most accurate results in trying to assess behaviour change
quantifying behavioural change and cost-effectiveness is difficult but can provide vital information for the structure and funding of future programmes.

Scaling up such programmes appears to depend on: obtaining tangible results from careful investigation of people's wants, needs and habits; integration with the government health administration; and the establishment of a committed NGO to direct the process.

Source(s):
‘Hygiene promotion in Burkina Faso and Zimbabwe: New approaches to behaviour change’, Field Note #7, World Bank Water and Sanitation Programme, Africa Region, by M. Sidibe and V. Curtis, 2002 Full document.
'Towards better programming: a manual on hygiene promotion', Unicef Programme Division Technical Guidelines Series, by V. Curtis and B. Kanki, 1999
'Effect of washing hands with soap on diarrhoea risk in the community: a systematic review', The Lancet Infectious Diseases 3: 275-281, by V. Curtis and S. Cairncross, 2003

Funded by: Unicef; WHO

id21 Research Highlight: 26 January 2004

Further Information:
World Bank Water and Sanitation Programme, Africa Region
The World Bank
Hill Park, Upper Hill
PO Box 30577
Nairobi
Kenya

Tel: (254-2) 260300, 260400
Fax: (254-2) 260386
Contact the contributor: wspaf@worldbank.org

London School of Hygiene and Tropical Medicine, UK

World Bank Water and Sanitation Programme, Africa Region

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