The 8 Steps for Hygiene Promotion in Emergencies guideline is an eight step systematic, structured approach to ensure that hygiene promotion (HP) is effective, relevant to the context and is accountable to communities. There is an e-learning module to train staff and volunteers.

During an emergency response HP has often focused on ‘disseminating messages’ rather than meaningful engagement with the community. The eight step approach highlights the need for Community Engagement (chapter  E ) at all stages of the programme, listening and working with the affected community, ensuring the response is effective and appropriate to the needs. It is important to work systematically through the key steps, rather than initiate HP activities that may not be appropriate for the context, e.g. overlooking the most vulnerable groups or potential Barriers and Motivators T.3 for behaviour change. The eight steps and key content are:

Step 1: Identifying the problem: understanding the causes and consequences, needs and capacities of the community 

Step 2: Identifying target groups: understanding who should be prioritised and their communication needs and preferences

Step 3: Analysing Barriers and Motivators T.3 for behaviour change: understanding people’s behaviour, their influences, values, beliefs and social pressures

Step 4: Formulating HP objectives: setting objectives that enable people to take action 

Step 5: Planning: developing an HP plan, designing HP methods, tools and materials 

Step 6: Implementing: training and supervising volunteers, linking with ‘hardware’ and relief distributions 

Step 7: Monitoring M.2 and Evaluation M.3: selecting monitoring methods, indicators and the evaluation focus 

Step 8: Reviewing and re-adjusting: emphasising an iterative process, programme documentation and hand-over 

The focus is on HP for a variety of public health risks related to safe disposal of excreta, effective handwashing and reducing the contamination of household drinking water. Although every situation is different, this systematic approach assists with quality assurance, links to agreed standards, supports effective implementation and uses monitoring and feedback to guide programme revisions. 

Tools and Methods used

The guide includes a wide variety of tools and methods, depending on the community and emergency context. It particularly emphasises participatory methods such as: 

• Focus Group Discussions T.14
• Pocket-Chart Voting T.31
• Three-Pile Sorting T.51
• Community Drama, Cinema and Puppet Theatre T.6
• Songs and Stories T.47
• Household Visit T.18
• Barrier and Motivator Analysis T.3

Applicability

The main focus is on emergencies and humanitarian contexts, although it is useful in all contexts including rural, urban or camp situations and longer-term responses. The main advantage of the eight step approach is to encourage the WASH team to think logically through the process of an HP response, rather than starting with a message-based response. The guide is easily adapted and replicable in all situations. It is available in different languages (e.g. English, French, Spanish and Arabic). A corresponding free e-learning course is available in English, French, Spanish and Russian.

Main Requirements / Investments Needed

An HP team is needed to implement the key HP actions throughout the project cycle using community-based volunteers. The team should be appropriately trained (depending on the needs) with a focus on Community Engagement (chapter  E ), participatory approaches and Accountability M.4 along with hygiene and health. Supervision and monitoring of community-based volunteers need to be planned and budgeted for. Resources such as office equipment, stationery supplies and IEC T.19 materials that can be used for various activities are also needed. IFRC’s HP Box includes a selection of items that are useful for hygiene promoters to rapidly start activities immediately after a disaster. It includes example picture cards for four different regions (Africa, Asia, Middle East and North Africa and the Americas), materials to make puppets, loud-speakers, materials to make a banner, example posters and basic office stationery. 

Evidence of Effectiveness

An increasing number of National Societies’ staff and volunteers have completed the online e-learning module or have been trained using the eight steps outlined in the guide. The IFRC has noted improvements in the quality and depth of HP plans and activities through the use of the systematic step-by-step approach.

Do

• Engage with all sectors of the community and at all stages of the programme; listen and discuss to understand the problem, the context and the needs

• Focus on participatory methods and communication channels that are trusted and appropriate

• Consider the barriers and motivators to behaviour change: reduce the barriers and build on the motivators!

Don't

• Do not only rely on campaigns with one-way messaging but also think about two-way communication through trusted channels

• Do not just rely on increasing knowledge, as knowledge may not lead to action

• Do not make assumptions: talk with people and observe

Practical Example

In 2020 the Hellenic Red Cross, with IFRC and partners, used the approach to implement HP in Moria camp, Lesbos, Greece. Several rapid assessments were done using local volunteers from the five main ethnic groups (or nationalities) present in the camp. The assessments investigated socio-cultural aspects, communication preferences and ways to increase trust. Based on this information and in dialogue with the community, decisions were made on the feasible siting of WASH facilities. Hygiene promotion activities included the use of puppets, murals and other engaging activities for children. Feedback was actively collected and used to revise and improve the facilities and activities. For example, men requested baby showering facilities (as they were also responsible for caring for children). Tables with small basins to bathe infants were then added to the male facilities. Single women in some areas of the camp reported feeling afraid to use the toilets or showers at night. In response, the WASH team collaborated with the government to move those women to shelters right next to the shower blocks, so they did not have to walk through the camp at night to reach the facilities.