Selecting and Distributing Hygiene Items

According to the Sphere Project Minimum Standard 2, refugees and Internally Displaced People (IDP) have the right to hygiene items to maintain health, dignity and well-being (THE SPHERE PROJECT 2011a). The affected population in short-term Camps and Prolonged Encampments should be involved in selecting the most appropriate items for their community and they should also be involved in promoting the proper use of them. Hygiene item distribution should be organised as rapidly as possible as the affected population may arrive without possessions (HARVEY 2015).

Coordination is key for the selection and distribution of hygiene items in order to ensure that the needs for hygiene items are met and maximum health benefits achieved (THE SPHERE PROJECT 2011b). Coordination safeguards that hygiene kits are consistently distributed throughout the camps. It also assists in avoiding duplication, in identifying opportunities for large-scale procurements geared to increase efficiency, as well as in identifying gaps in the provision of hygiene items (OXFAM 2013).

Coordination should take place between:

• the WASH team (a set of professionals responsible for leading the emergency WASH response in regards to staffing, planning, implementation and execution of the response).
• hygiene promoters (responsible for selecting items and coordinating with logisticians),
• the shelter cluster (who distributes other non-good items kits), and
• the affected population.

The selected and distributed hygiene items should enable the following (OXFAM 2008 and HARVEY 2015):

• safe storage of drinking water,
• good practise around drinking water use and household level water treatment,
• the practise of handwashing by members of a household at all times,
• maintenance and cleaning of latrines,
• washing of self and of clothes,
• management of babies and young children’s faeces,
• management of women`s menstruation,
• the practise of good food hygiene practises, and
• maintenance of compound or camp cleanliness.

Hygiene items are generally divided into basic and additional items. Basic hygiene items are those required immediately after the arrival of refugees and IDPs at the Camps in order to meet most critical needs and to address highest health risk factors. Basic hygiene times include (note that references in brackets indicate which organisations recommend these as basic hygiene items):

• 10-20 litre (L) capacity water container for transportation per household (THE SPHERE PROJECT 2011b, HARVEY 2015).
• 10-20 L capacity water container for storage per household plus enough storage capacity to ensure there is always water available in the household (THE SPHERE PROJECT 2011b, HARVEY 2015).
• 450 grammes (g) of soap per person per month (250 g for bathing and 200 g for laundry) (THE SPHERE PROJECT 2011b, UNHCR 2015).
• Culturally acceptable material for menstrual health (sanitary towels, napkins, absorbent cotton) (THE SPHERE PROJECT 2011b, UNHCR 2015, OXFAM 2013). The suggested amount could include 2 meters (per 6 months) absorbent cotton or 12 (per month) disposable sanitary napkins (JOHN HOPKINS and IFRC 2008, UNHCR 2006, HARVEY 2015).

Additional items fulfill important needs that are less critical and are determined through consultation with the affected population (GWC 2009). Additional hygiene items for personal and communal hygiene may include:

• 75 millilitres (ml)/100 g toothpaste per person per month (THE SPHERE PROJECT 2011b, HARVEY 2015)
• 1 toothbrush per person (THE SPHERE PROJECT 2011b, HARVEY 2015)
• 250 ml shampoo per household per month (THE SPHERE PROJECT 2011b)
• 250 ml lotion per infant/child per month (THE SPHERE PROJECT 2011b)
• 1 laundry basin per household (HARVEY 2015)
• 40 m washing line per household (HARVEY 2015)
• 80 washing pegs per household (HARVEY 2015)
• 1 disposable razor per household (THE SPHERE PROJECT 2011b)
• 1 hairbrush/comb per household (THE SPHERE PROJECT 2011b)
• 1 hair scissors per household (HARVEY 2015)
• 1 pair nail clippers per household (THE SPHERE PROJECT 2011b)
• 6 underwear for women and men (and children where appropriate) per person per year (GWC 2009, JOHN HOPKINS and ICRC 2008, UNCHR 2006).
• Diapers and nappies for infants and children under the age of two (THE SPHERE PROJECT 2011b, OXFAM 2013, GWC 2009)
• 250 ml diaper rash prevention lotion per household with infants (GWC 2009)
• Potties for young children (GWC 2009)
• Anal cleansing containers (GWC 2009)
• Insecticide-treated nets (GWC 2009)
• Oral rehydration’s salts (GWC 2009)
• 1 small yard brush per household (HARVEY 2015)
• 1 small (40 L) dustbin per household (HARVEY 2015)
• For communal hygiene: tools and equipment for digging and cleaning latrines or digging drainage (e.g. shovels, picks, wheelbarrows, buckets, boots) (GWC 2009)

Early consultation and communication with the affected population and their hygiene promoters is required to identify the basic and priority items that are both appropriate and applicable (GWC 2009, THE SPHERE PROJECT, IOM, NRC AND UNHCR 2015, UNHCR 2015). It is especially important to consult women as they are often most aware of their household needs and have specific requirements for menstrual hygiene (OXFAM 2013; see invalid link factsheet).

During the consultation, familiar cultural norm practices and products of the affected population should be determined and integrated into the selection process. Focus Groups can be instrumental to ensuring that distributed hygiene items relevant and appropriate (HARVEY 2015).

Plans should be made to provide training on the proper use of those hygiene items that are unfamiliar to the affected population but are required to protect them from key health risks. Otherwise, items may be used or not used altogether (GWC 2009).

Each Camps requires a distribution plan that is set up early on and in coordination with logisticians, in order to ensure effective and efficient distribution from the beginning and throughout the camp life cycle (GWC 2009). The distribution plan should set clear lines of responsibility between humanitarian actors in terms of ensuring that the proper type, quality and timeliness of the hygiene items is provided and in terms of post-distribution monitoring (see below) (HARVEY 2015).

Timely distribution of items is necessary to meet the immediate needs of the affected population (THE SPHERE PROJECT 2011b). To facilitate the distribution, the population should be provided with information on (adapted from THE SPHERE PROJECT 2011b):

• the timing of distribution and upcoming distributions,
• location of distribution point(s),
• the content of hygiene kits,
• target groups within the population (if applicable), and
• upcoming training and basic information on use of the hygiene item kits.

Beneficiaries should be registered and records of items distributed kept.

One possible approach to distributing hygiene items is the Global Wash Cluster (2009) three phase distribution approach. This approach suggests that in the first phase, the basic items of two water containers and a two-week supply of soap is delivered upon arrival at the camp. If pre-stocking priority hygiene was done in the planning of the hygiene promotion campaign, rapid mass distributions are possible in the early phase of the emergency (see invalid link factsheet). In the second phase, the remaining basic items and additional items of priority for addressing key health risk factors (such as household level water treatment and potties for children) are supplied. These are recommended to be distributed two weeks following the affected population's arrival at the camp. The third phase includes distributing additional items identified through consultation that can be distributed a month or a month and a half following the arrival at the camp (GWC 2009). Hygiene items can be packaged with other non-food items kits for improved packaging and distribution (GWC 2009).

Depending on the context of the camp, other approaches may be sought to supplement or replace traditional and centralised distribution. Such alternatives include cash-based approaches as well as distribution through remunerated hygiene mobilisers.

Cash- or marked-based approaches are recommended if hygiene products are readily available on the local market in rural and urban settings; however, this is less possible in traditional camp settings in early stages (HARVEY 2015). In fact, when markets are functional and refugees and IDPs can be provided with access to them, the UNHCR global 2014-2018 strategy recommends providing cash and vouchers to refugees to buy their own hygiene items (UNHCR 2014). This is only effective if the basic needs and livelihoods of the affected people are taken care of as otherwise hygiene items may be sold to support family livelihoods.

Deploying community mobilisers for the distribution of hygiene items or vouchers can be a meaningful way to enhance the participation of the affected population in questions around personal hygiene. Community mobilisers are themselves members of the community (see invalid link factsheet) and may thus find it easier to interact with the population than external actors. Community mobilisers play an important role in hygiene promotion campaigns and as such may be able to take up the distribution of hygiene items/vouchers as one of many tasks. Hygiene mobilisers may be paid in cash or in kind (GWC 2009). The appropriateness of this option should be determined in consultation with the hygiene mobilisers or volunteers in questions.

Cost savings in procuring hygiene items may be achieved by investigating options for sourcing hygiene items through local markets (especially relevant in collective centres) (OXFAM 2013).

In order to ensure the affected population has the hygiene items they need throughout their stay at the camp, post-distribution surveys should be conducted to reassess needs for hygiene times and replacement of consumable and non-consumable items. The Sphere Project (2011) minimum standards specify that a standard distribution monitoring system should be set up to monitor a) the need for replenishment of items, b) whether items are actually being used and c) the levels of satisfaction with the kits among the affected population (THE SPHERE PROJECT 2011b, GWC 2009, HARVEY 2015). This post-distribution monitoring also provides a framework for receiving feedback and identifying gaps in the current hygiene kits. The UNHCR emergency hygiene standards set out criteria for monitoring (UNHCR 2015).

Post-distribution monitoring should take less than a day and should include random household surveys and Focus Groups (HARVEY 2015).

The guidance provided in this factsheet is intended primarily for planned Camps or collective centres for refugees and IDPs, where there is centralised management of refugees and IDPs. It is applicable where camp managers or humanitarian actors are responsible for providing hygiene items to an affected population concentrated in an area.

The factsheets is also applicable to Prolonged Encampments. In this setting, market-based approaches (providing vouchers or cash to the affected population to buy their own hygiene items from local vendors) are especially appropriate, if market access has been established. Part of the reason why this is often more effective than centralised distribution is that limitations to traditional humanitarian funding resources are often a major concern in prolonged encampment settings (CRONIN et al 2008). In prolonged encampment situations, basic items have long been distributed and replenishments of consumable hygiene items such as soap and menstrual material are required. In this setting, household surveys are key to assess the need for replacement of non-food items such as water containers.