Camp Hygiene Promotion Campaigning in Early-Stage Emergencies

Systematic and participative planning approaches are needed to implement effective hygiene promotion campaigns. They promote positive behavioural change around household, food and personal hygiene and can facilitate meeting the The Sphere Project Standards Minimum Standards (UNHCR 2015a, THE SPHERE PROJECT 2011, GWC 2009). Careful planning, execution, monitoring and evaluation of hygiene promotion campaigns ensure that refugees and Internally Displaced People (IDPs) have the knowledge, resources, willingness and practice to prevent WASH-related disease transmission of concern in camp settings (HARVEY 2015, WHO AND WEDC 2016). 

Hygiene promotion campaigns are pivotal to successful WASH interventions. Campaigns for hygiene promotion tend to be more effective if coordinated with sanitation and water supply interventions (IOM, NRC AND UNHCR 2015a). In Camps, the refugees and IDPs have often lost all personal possession. To prevent them from selling water supply and sanitation items that are distributed to them, their livelihoods must be considered in the planning of hygiene promotion campaigns (THE SPHERE PROJECT 2011).

Depending on the stage of the humanitarian crisis (e.g. early emergency, post-acute emergency or prolonged, protracted crisis), hygiene promotion strategies vary in terms of intensity and scale of the intervention (GWC 2009). During early emergencies, challenges of overcrowding, poor living conditions, the trauma of displacement and commonly the loss of possessions create an acute and immediate need for interventions (such as distribution of hygiene items and dissemination of information on the most concerning health risk factors) that prevent further deterioration of living conditions and promote good personal hygiene practices (HARVEY 2015). 

Campaigns at the early emergency stage focus on saving lives and preventing WASH-related diarrhoeal disease by encouraging (IOM, NRC AND UNHCR 2015, HARVEY 2015):

• Safe disposal of excreta
• Effective hand washing
• Reducing the contamination of household drinking water

Priority actions for the early emergency stage include the Selecting and Distributing Hygiene Items distribution of basic hygiene materials such as soap, water containers and mensural hygiene material at the arrival of the refugees or IDPs in the camp. At the earliest opportunity, discussions with members of the refugee and IDP populations should take place to ensure the items are appropriate to the context and culture (HARVEY 2015, see Selecting and Distributing Hygiene Items factsheet). At the same time, steps are to be taken to ensure that the refugee population obtains the necessary knowledge to prevent diseases (HARVEY 2015).

The early emergency context will often not allow for interactive methods due to time restrictions (GWC 2015). Hygiene promotion should, therefore, adopt a phased approach that first provides the refugees and IDPs with the necessary resources and then attempts to mobilise the community wherever possible to actively participate in tackling WASH-related problems (e.g. safe disposal of excreta, clean up and safe management of waste) and in the design and management of WASH services.

Camps with early investments in behavioural change programs often see the population practising good hygiene behaviour for many years. Investment in behavioural change interventions are therefore a cost-effective and sustainable method of intervention (CRONIN ET AL 2008). Approaches such as invalid link can be an effective community mobilisation approach but may be difficult to implement in early emergency phases due to time constraints for implementation and training of facilitators. Such approaches are therefore mostly relevant for later emergency phases (see Camp Hygiene Promotion Campaigning in Later-Stage Emergencies factsheet).

Hygiene Committee or Health Clubs

All WASH programs should have hygiene committees or health clubs developed and run in cooperation with the refugee and IDP population and the host communities (UNHCR 2015b). Community-based WASH committees can encourage and support refugee populations to take an active role in operations and maintenance of sanitation facilities, which helps to safeguard good hygiene in the longer term (IOM, NRC AND UNHCR 2015). All programs should have a gender-balanced and representative committee responsible for promoting hygiene and implementing hygiene promotion campaigns. If such committees a reset up, clear roles, responsibilities, rules and regulations must be defined for both professional hygiene promoters and community mobilisers from the refugee / IDP population (see Recruiting and Training of Hygiene Promotion Facilitators factsheet). Additionally, hygiene promotion should be coordinated with education efforts and opportunities should be sought to carry out hygiene promotion in schools (see School Campaigns (DC) factsheet) (HARVEY 2015).

Mobilising the community for hygiene promotion is best done in a phased approach according to the stage of the emergency or humanitarian crisis (HARVEY AND CONOLI 2015). In the immediate emergency phase, hygiene promotion should focus on (HARVEY AND CONOLI 2015):

• Ensuring necessary resources are provided to the refugee/IDP population to carry out proper hygiene.
• Mobilising the community to address WASH-related problems.
• Mobilising the community to take action concerning the design, use, management of WASH services.
• Ensuring that the refugee population has the basic knowledge to prevent disease.

Generally, there are two crucial matters in hygiene promotion that must be carefully planned for: 1) the distribution of hygiene sanitary products and cleaning tools or the availability of latrines (Sphere Standard 2) and 2) the implementation of a hygiene program (Sphere Standard 1) (IOM, NRC AND UNHCR 2015, THE SPHERE PROJECT 2011). The following steps should be taken when carrying out a hygiene promotion campaign in the early emergency stage:

Initial Preparedness

Proper Emergency Preparedness and Contingency Planning, stockpiling of equipment and training personnel ahead of time allows for governments, humanitarian organisation and individuals to anticipate and respond effectively to health risks and to promote hygiene (THE SPHERE PROJECT 2011). Preparedness is particularly important for the acute emergency stage, where the needs are urgent but reaction times limited. The better the stakeholders are prepared for the situation, the easier it will be for them to deliver a targeted approach (see invalid link factsheet).

Defining the Campaign Strategy

Every camp should have a context-specific hygiene promotion strategy in place that justifies ‘‘WHY hygiene promotion is important in the specific context, HOW the key hygiene risk practices have been identified, WHO are the priority at-risk groups and WHY, WHAT are the most effective hygiene promotion approaches and activities and WHY, HOW the target activities for each at-risk group will carry out and HOW the effectiveness of the plan will be monitored’’ (HARVEY 2015). The following components should be addressed by the strategy and prioritised according to the risk assessment: community and individual action, Ensuring Appropriate Operations and Maintenance Services, Selecting and Distributing Hygiene Items, monitoring, community participation and communication with WASH stakeholders (see graph below).

Planning and Preparation

Suggested assessment and preparation steps for developing a hygiene promotion campaign for the early emergency stage are as follows (adapted from GWC 2009 and HARVEY 2015):

Step 1: Assessment

• Identify key risk practices and get an idea of the level of knowledge, the practices and level of understanding of WASH;
• Determine which practices allow for diarrhoeal microbes or diseases transmission;
• Identify the practices that are the most harmful to human health.

Step 2: Consultation

• As soon as possible, consult men, women and children on hygiene needs and items to include in hygiene kits.

Step 3: Initial planning through definition of goals and objectives

• Define the aim of the entire campaign based on the Camps unique needs that were revealed in the needs assessment (see WASH Needs Assessment factsheet). For early stage emergencies, this should be carried out within the first days of the emergency;
• Set one or two purpose objectives referring to the wider objectives of the campaign and targeting specific hygiene practices. Select these based on which practices have the greatest potential impact on public health and which are achievable. Also, consider what can be done to enable change of risk practices;
• Determine two to four outputs that should be achieved;
• Select measurable indicators and means of verification for each objective (such as those in Sphere Project Hygiene Promotion);
• Identify potential areas for intervention (e.g. on the hardware side such as water systems or hygiene items, or on the software side such as education or advocacy);
• Set out action plans for achieving the objectives.

Step 4: Planning through Identifying target audiences and stakeholders

• Decide on which segments of the refugee/IDP population will be targeted by the campaign, based on an assessment of risky hygiene practices;
• Determine important stakeholders who influence the people that employ these risky practices (teacher, community leaders, etc.).

Step 5: Planning communication campaigns and modes of intervention

• Decide on initial key messages (such as WHO`s Facts for Life). In early stages, mass media is effective, as 60% of people have radio although they are often only used by men;
• Define the initial mode of intervention for media campaigns (see Media Campaigns - Radio (DC), and Creating Information Material (DC) factsheets) as well as for other means that the target audiences trust (women`s discussion groups, traditional healer). Also, define locations where to best reach target groups (consider gender).
• Determine advocacy and training needs for stakeholders (see Recruiting and Training of Hygiene Promotion Facilitators factsheet).

Step 6: Recruitment, identification and training of workers and outreach system

• Base recruitment and training on the capacities (systems, skills and approaches) that already exist among the active humanitarian actors in the camp (see Recruiting and Training of Hygiene Promotion Facilitators factsheet).

Implementation and Continued Assessment

• Implement the defined actions (e.g. Selecting and Distributing Hygiene Items or carrying out media campaigns).
• Hold meetings/ interviews with key informants and stakeholders to initiate a more interactive approach.
• Monitor and evaluate hygiene promotion campaigns against hygiene-related indicators on safe access to quality sanitation and on satisfactory living condition (UNHCR 2015a). The relevant indicators for the early emergency stage include (UNHCR 2015a):
  • ≥90% of households have soap present in the house (which can be presented within 1 minute),
  • ≥60% of households can name 3 of the 5 circumstances in which it is critical to wash hands
  • ≤ 500 refugees/IDPs per hygiene promoter
  • Availability of 450 grammes/person/month of soap.
• Reassess, adapt and redesign hygiene promotion campaigns (see Camp Hygiene Promotion Campaigning in Later-Stage Emergencies factsheet).

Hygiene promotion campaigns are to be completed within the first three months of the displacement emergency and then redesigned every six months based on the monitoring (HARVEY 2015).

The guidance is applicable to early emergency stages in Camps or collective settlements. The information is also useful for existing camps which either receive a new influx of refugees or IDPs or where conditions change significantly.