Camp Hygiene Promotion Campaigning in Later-Stage Emergencies

Systematic and participatory planning approaches are needed to implement effective hygiene promotion campaigns in camps during early- and later-stage emergencies. They promote positive behavioural change around household, food and personal hygiene and facilitate meeting the The Sphere Project StandardsMinimum Standards (UNHCR 2015, THE SPHERE PROJECT 2011, GWC 2009). Careful planning, execution, monitoring and evaluation will ensure humanitarian actors can provide appropriate support and refugees and Internally Displaced People (IDPs) are empowered with the knowledge, resources, willingness and practice to prevent diseases of concern in camps and prolonged encampment settings (HARVEY 2015, WHO AND WEDC 2011).

Depending on the stage of the humanitarian crisis (e.g. early emergency, later/post-acute emergency, or prolonged, protracted crisis), hygiene promotion strategies vary in terms of intensity and scale of the intervention (GWC 2009).

In later-stage emergencies, the situation is usually already well assessed and more time is available for hygiene promotion activities. The breadth of issues covered by hygiene promotion campaigns can therefore be expanded from the most pressing issue of diarrheal diseases prevention to also address other hygiene concerns and risk factors such as transmission of environment-related diseases (IOM, NRC AND UNHCR 2015, HARVEY 2015, WHO AND WEDC 2016).

As the situation stabilises in the later emergency stage, refugees and IDPs can increasingly participate in the design and management of WASH services as well as in disease prevention (HARVEY 2015). Accordingly, the range of communication and collaboration platforms and approaches should be diversified to also include Media Campaigns - Radio (DC)/TV broadcast, public announcements, Media Campaigns - Posters and Flyers (DC), signs, paintings and cartoons (see Creating Information Material (DC) factsheet), meetings and Focus Groups, celebrations, traditional and community events, film and video presentations, as well as dramas, role plays, games and songs (IOM, NRC AND UNHCR 2015). The communication methods should always be chosen based on an assessment of the cultural norms of the refugee/IDP population through consultation and participation. 

Positive Behavioural Change and Community Engagement around Hygiene in Later Emergency Stages

Camps, where investments in behavioural change programs were made during the emergency phase, 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 and thus very relevant for later-stage emergencies (CRONIN ET AL 2008). As such, the later emergency stage is a key time to focus on community mobilisation and to engage the community through participatory processes such as Participative Hygiene and Sanitation Transformation (see invalid link factsheet).

Hygiene Committees 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 gender-balanced and representative committees that are responsible for promoting hygiene and implementing hygiene promotion campaigns. If such committees are set up, clear roles, responsibilities, rules and regulations must be defined for both professional hygiene promoters and community mobilisers from the refugee / IDP population (see invalid link 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 that is adapted 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 act to address WASH-related problems.
• Mobilising the community to act concerning the design, use, management of WASH services.
• Ensuring that the refugee population has the basic knowledge to prevent disease.

In the medium- to long-term post-emergency phase, on the other hand, hygiene promotion should follow an approach more in line with development settings, involving continuous assessment, analysis, design, implementation, monitoring and evaluation of risks (a concept commonly referred to as Linking Relief, Rehabilitation and Development LRRD) (HARVEY 2015).

Generally, there are two crucial matters in hygiene promotion campaigning that must be carefully plan 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 later-stage emergencies:

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). If the strategy has not been set out during the early emergency stage, this should be rectified as soon as possible during the later emergency stage. The following components should be addressed by the strategy and prioritised according to a continuous risk (re-)assessment: community and individual action, Ensuring Appropriate Operations and Maintenance Services,Selecting and Distributing Hygiene Items, monitoring, community participation and communication with WASH stakeholders.

Planning and Preparation

The six planning and preparation steps for hygiene promotion campaigns (assessment, consultation, initial planning through goals and objectives, planning through target audiences and stakeholders, planning of communication campaigns and modes of intervention and recruiting, identification and training of field workers and outreach systems) are usually carried out during the early emergency stage (see Camp Hygiene Promotion Campaigning in Early-Stage Emergencies factsheet). The later emergency stage, on the other hand, focuses on implementation, monitoring and adaptation.

Implementation, Monitoring and Adaptation

While Hygiene Promotion and Community Mobilisation in Camps focuses on planning and preparation, activities in later emergency stages primarily focus on ensuring that the hygiene promotion campaign continues to work towards meeting its goals and objectives and adapts to the changing needs of the refugee and IDP population (adapted from GWC 2009 and HARVEY 2015):

Implementation and ongoing assessment of the situation

• Conduct ongoing assessments to understand the motivation factors behind positive behaviour change around hygiene.
• Obtain quantitative data and carry out a systematic data collection in a participatory manner and in coordination with other sectors.

Monitoring

• Monitor the hygiene promotion activities (e.g. distribution of hygiene kits, installation of toilets) and people’s level of satisfaction.
• Monitor and evaluate hygiene promotion campaigns against hygiene-related indicators on safe access to quality sanitation and on satisfactory living condition (UNHCR 2015). The relevant indicators for the later emergency stage include:
  • ≥ 90% of households have soap present in the house (which can be presented within 1 minute),
  • ≥ 80% of households are 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. Actual needs are to be determined based on monitoring results.

Adaptation

• Refine the campaign based on the changing situation and move towards more interactive methods of communication and participation in comparison to earlier emergency stages.
• Rapidly adapt the intervention and campaign based on monitoring outcomes and empower the communities to maintain their longer-term hygiene promotion structure (e.g. committees).
• Continue training and monitoring and adapt approaches as necessary.

Hygiene promotion plans should be revised every six months based on monitoring outcomes (HARVEY 2015).

The guidance is applicable to later emergency stages in Camps or collective settlements.