Hygiene Promotion Campaigning in Prolonged Encampments

In Prolonged Encampments, the systematic and participatory planning approaches to hygiene promotion which are typically implemented in earlier emergency phases (see invalid link factsheet), need to be maintained and adapted to ensure continuation of positive behavioural change around household, food and personal hygiene, towards achieving the The Sphere Project Standards Minimum Standards (UNHCR 2015a, THE SPHERE PROJECT 2011, GWC 2009). The refugees and Internally Displaced People (IDPs) should be empowered with the knowledge, resources, willingness and practice to continue to prevent diseases of concern and adjust to changing conditions in prolonged encampment settings (HARVEY 2015, WHO AND WEDC 2011).

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

Prolonged encampment settings are often referred to as “forgotten crises” and often face challenges of a lack of access, inappropriate interventions, uncoordinated response and tight financial resources (CRONIN et al. 2008). Awareness of the implications of resource gaps in water, sanitation and hygiene services is often lacking (CRONIN et al. 2008). A specific challenge for hygiene promotion in prolonged encampments is that members of the camp population may become worn down by the protracted nature of the crisis and consequently, their behaviours around hygiene may deteriorate. Furthermore, often the stakeholders lack a shared vision for the camp, partly due to protracted disputes, political differences and conflict of interests (IOM, NRC AND UNHCR 2015). As such, strong coordination of WASH stakeholders is particularly important but at the same time presents a major challenge (CRONIN et al. 2008; IOM, NRC AND UNHCR 2015). Targeted priority interventions that address the persistent or newly emerging specific risk factors need to be taken (CRONIN et al. 2008).

In prolonged encampment settings, the focus of hygiene promotion campaigns lies no longer on life-saving and protection but rather on meeting comprehensive needs for hygiene and maintained health beyond basic needs (including, for example, environment-related diseases). In addition, humanitarian assistance in prolonged encampments must focus on the affected population’s rights and essential economic, social and psychological needs (UNHCR 2005). In prolonged encampments, one good model for humanitarian assistance is to move away from traditional assistance towards focusing on promoting self-reliance, creating economic opportunities and strengthening cost-sharing models (KONYNDYK 2005).

As prolonged encampments are more stabilised than Camps, it is more important than ever to engage the affected communities and to promote long-term health benefits through sustained behavioural change (HARVEY 2015; BIRAN et al. 2012). In camps where investments in behavioural change programs were made during the immediate emergency phase, the population is often seen to practice good hygiene behaviour for many years. Investment in behavioural change interventions are a cost-effective and sustainable method of intervention and thus very relevant for prolonged encampment settings (CRONIN et al. 2008). This is especially important because the affected population may become worn down by the protracted nature of the crisis, which may cause them to face psycho-social problems related to unemployment, unequal access to employment possibilities or alcohol abuse (IOM, NRC AND UNHCR 2015). This may result in an increased risk for exploitation, abuse or illness (ROBINSON AND ALPAR 2009, UNHCR 2015b, DEMO 2009). Community mobilisation frameworks such as Community-Led Total Sanitation (CLTS) and Participatory Hygiene and Sanitation Transformation (PHAST) present widely used and tailor-made methods of hygiene promotion that are very appropriate for prolonged encampment settings (PIN 2012).

Hygiene Committee or Health Clubs

All WASH programs should, if possible, have hygiene committees or health clubs developed and run in cooperation with the refugee and IDP population (UNHCR 2015b). This can facilitate participation of refugees and IDPs in the (re)design and management of WASH services, in continued disease prevention and in hygiene education (HARVEY 2015, BIRAN et al. 2012). Community-based WASH committees can encourage and support refugee populations to take an active role in Ensuring Appropriate Operations and Maintenance Services (O&M) of sanitation facilities, which helps to ensure good hygiene in the long-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 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).

The range of communication and collaboration platforms and approaches used for hygiene promotion should be diversified in prolonged encampment settings and should include Media Campaigns - Radio (DC)/TV broadcast, public announcements, Media Campaigns - Posters and Flyers (DC), signs, paintings and cartoons, 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 a thorough, participatory assessment of the cultural norms of the refugee/IDP population. Education clusters are often activated in prolonged encampment situations and this can open a new avenue for hygiene education (see School Campaigns (DC) factsheet) (IOM, NRC AND UNHCR 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 COLONI 2015). In the medium- to long term post-emergency phase of prolonged encampments, 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).

Defining the Campaign Strategy

Every camp should have a context-specific hygiene promotion strategy set up in the early emergency stage that justifies WHY hygiene promotion is important in the specific context, HOW the key hygiene risk practices have been identified, WHO the priority at-risk groups are, WHAT the most effective hygiene promotion approaches and activities are, HOW the target activities for each at-risk group will be carried out and HOW the effectiveness of the plan will be monitored (HARVEY 2015). If the strategy has not been set and defined during the early emergency stage, this should be rectified for prolonged encampments. 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.

Campaign Planning and Revision

While planning activities of the Camp Hygiene Promotion Campaigning in Early-Stage Emergencies focus on preparation (assessment, consultation, definition of goals and objectives, identification of target audiences and stakeholders, campaign planning and recruitment) and on addressing basic needs, planning activities in Camp Hygiene Promotion Campaigning in Later-Stage Emergencies and prolonged encampment settings focus on ensuring that the hygiene promotion campaign goes beyond addressing basic needs towards meeting all locally relevant health and hygiene issues. The campaign should continue to work towards meeting its relevant goals through implementation, monitoring and adaptation of the campaign as required (adapted from GWC 2009 and HARVEY 2015, BIRAN et al. 2012).

The steps for addressing campaign implementation and adaptation relevant for prolonged encampments include (adapted from GWC 2009 and HARVEY 2015, BIRAN et al. 2012):

Implementation and ongoing assessment of the situation

• Conduct ongoing assessments to understand the motivation factors behind positive behavioural change around hygiene.
• Assess the heterogeneity in the camp population and the associated behaviour and risk practices.
• 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 2015a). The relevant indicators for the prolonged encampments (referred to in standards as “post emergency stage”) include:
  • ≥ 90% of households have soap present in the house (which can be presented within 1 minute),
  •  ≥ 80% 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 grams/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.
• Based on an assessment of the heterogeneity, communication should be adapted to target the specific segments of the population identified to display certain risk practices.
• 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.

To ensure that the hygiene promotion campaign promotes practices that can be sustained in the long term, the following points should be considered (IA 2014):

• Use multiple communication methods and make use of hygiene promoters, schools, women’s groups, youth groups and mass media;
• Carry out multi-sector planning and delivery together with health, child protection, livelihoods and non-food items sectors;
• Increase participation and decision making of beneficiaries;
• Use a child-centred approaches;
• Approach disease monitoring and awareness campaign in an integrated health and education manner;
• Support and strengthen WASH committees and health clubs;
• Monitor and conduct impact assessment and use the information gathered in programme planning and adapting hygiene promotion campaigns.
• Ensure systems are in place for Operation and Maintenance (O&M) of facilities to enable maintaining good hygiene practices (see Ensuring Appropriate Operations and Maintenance Services factsheet).

The Role of Ongoing Assessments and Epidemiological Studies

Achieving long-term behavioural change can be supported by conducting hygiene Knowledge, Attitude and Practice (KAP) surveys and ongoing household assessments of the camp population. The information can be used to improve the targeting of beneficiaries, bringing awareness to Preventing Gender-Based Violence (Camps and Prolonged Encampments) and facilitating coordination with the partners, refugees and local authorities (EUROPEAN COMMISSION 2014). Moreover, detailed epidemiological studies can help to demonstrate the cost-benefit payback of effective hygiene promotion (EUROPEAN COMMISSION 2014). Such interventions help focusing the response to health risks specific to the camp and given context.

Planning Timelines

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

The guidance presented in this factsheet is applicable to Prolonged Encampments.