Glossary

Emergencies can arise in a range of contexts and can be either acute and time-limited or chronic and protracted. Hygiene promotion interventions need to take account of the various WASH challenges and community dynamics in different scenarios. Traumatic events associated with conflict, or losing loved ones, can interfere with people’s ability to process information and communicate; hygiene promoters must be aware of how to respond to people who are grieving. In some contexts, hygiene promoters will be working with both displaced and host communities. In others, the initial focus may be to support community reorganisation and, in some situations, work will only be possible remotely. 

The scenarios leading to emergencies can be broadly categorised as follows:

Emergencies Triggered by Natural or Technological Hazards: earthquakes, volcanic eruptions, landslides, floods, storms, droughts, temperature extremes and disease epidemics/pandemics (e.g. cholera, Ebola or COVID-19) are natural hazards that can cause humanitarian disasters, claiming many lives, causing economic loss and environmental and infrastructure damage. However, humanitarian disasters only occur if a hazard strikes where populations are vulnerable to the specific hazard. Such emergencies often result in deteriorating environmental health conditions, particularly of access to basic WASH services. Infrastructure such as schools, roads, hospitals and water and sanitation facilities are often directly affected, reducing access to clean water, sanitation and the ability to practice safe hygiene such as handwashing - increasing the risk of water and sanitation-related diseases.

Conflicts: refer to societally created emergencies such as political conflicts, armed confrontations and civil wars. Many internally displaced people or refugees have to be housed in camps, temporary shelters, or host communities where access to clean water, sanitation and other hygiene facilities and requirements needs to be guaranteed at very short notice - and often maintained over long periods. The majority of displaced people are absorbed by host communities. This can overburden the existing water supply (and sanitation) infrastructure, making it difficult to identify and quantify actual needs; upgrades to existing infrastructure may be required. Funding for WASH interventions - either for large populations integrated with host communities or in long-term camps - can be challenging; hygiene promotion can be seen as a luxury rather than a necessity. If people are displaced in large numbers, community structures and support mechanisms are often disrupted; response plans may need to support community reorganisation. Additional challenges arise if the conditions in the camp become better than those in the host communities, creating tension between the local and refugee populations. Such cases should be seen as opportunities to improve WASH services for both host and refugee communities. 

Fragile States: states can be considered fragile when they are unwilling or unable to meet their basic functions. For the affected population, safety may be at risk if basic social services are not provided or are poorly functioning. Weak government structures or a lack of government responsibility for ensuring basic services can increase poverty, inequality and social distrust and potentially develop into a humanitarian emergency. The provision of basic WASH services is frequently neglected by such states and external support using conventional government channels is often ineffective. A lack of adequate infrastructure can make hygiene promotion very challenging; advocating for increased funding and support may be vital. Affected communities may easily tire of the efforts of hygiene promoters unless they are based on genuine capacity, collaboration and engagement to address the problems.

(High) Risk Countries Continuously Affected by Disasters and Climate Change: many countries face enormous challenges from climate change and the increasing likelihood of associated natural hazards. The risk that natural events will turn into a disaster is largely determined by the vulnerability of each society or group, the susceptibility of its ecological or socio-economic systems and the impact of climate change on both occasional extreme events (e.g., heavy rains causing floods or landslides) and on gradual climatic changes (e.g. temporal shift of the rainy seasons). Climate change also exacerbates problems in countries that are already suffering from disasters. All WASH interventions require a stronger focus on preventative and Disaster Risk Reduction (DRR) measures: hygiene promotion will need to adapt accordingly.

Disasters can be a mix of several categories (e.g., fragile or conflict-affected states hit by a natural disaster). This makes response targeting more difficult (deciding for example whether to target those affected by the natural disaster or those affected by more chronic conditions). Disaster and crisis scenarios can be sudden onset (e.g., earthquakes or conflicts) or slow-onset (e.g. droughts that may lead to a prolonged food crisis) or fragile contexts that lead to a deterioration of services over time. Depending on the type of crisis, the population and infrastructure may be affected very differently. While some disasters lead to massive population movements (with implications for a comprehensive public health response) others may only affect the infrastructure (shifting the response focus to repairs and respective improvements). In the latter case, hygiene promotion would focus on facilitating community engagement and ensuring that the improvements or repairs to infrastructure deliver the greatest possible impact.

All hygiene promotion interventions require the management and staff capacity to deliver the programme effectively. There is no recognised professional qualification for hygiene promoters; as a result, emergency responses recruit from a wide variety of professions and backgrounds. Therefore training, capacity strengthening, support and supervision are key responsibilities of the programme. 

The main role of a hygiene promoter is to support community-level decision making and ensure that what is often a technically driven intervention is also people-focused. As a result, hygiene promoters’ main skill sets and competencies relate to communication and facilitation (e.g. active listening, empathy and the confidence to work with groups and communities). 

Where possible, hygiene promoters should be able to communicate in the preferred language of the affected community, have an open, positive attitude to diversity and inclusion and have some experience of working with communities. These skills are often more important than public health, behavioural or WASH knowledge. Depending on their job responsibilities, hygiene promoters may also need to keep records and write clear reports. 

It is important to recruit locally whenever possible and to strengthen the capacity of existing development staff to respond to emergencies. Staff may be seconded from government ministries or identified through local and national NGOs, helping to increase the resilience of national staff and communities to future crises.
 
Human Resources

Hygiene promotion can be implemented by a variety of people and institutions such as a government department, Community Based Organisation or NGO. Interventions can be carried out by paid national or international staff, volunteers, community organisations or a mixture of any of these. In a WASH emergency response, dedicated human resources for hygiene promotion is recommended, to ensure that time is fully allocated to work supportively and interactively with communities.

Staff and volunteers must know what is expected of them and be provided with up to date job descriptions and codes of conduct. New staff should also receive briefings and inductions. Recruiters should aim for a balanced and diverse team (e.g. in terms of gender, disability, background) including in management positions.

On-going support for staff and volunteers must be provided and they must be aware of who will directly manage them. Competency frameworks should be developed to inform discussions with staff, helping to identify strengths, weaknesses and further training and support strategies. As soon as possible, a training plan for all staff and volunteers should be established. Organisations have a duty of care for their workers and must take measures to ensure their safety, manage stress, health and safety and personal security. At the same time, staff and volunteers must take responsibility for their own security and wellbeing and adhere to organisational guidelines and policies. Hygiene promotion staff and volunteers also need the resources to enable them to do their job, such as materials, equipment and means of travel.

Short staff deployments often lead to high staff turnover, undermine continuity and programme quality. They can result in a reduced sense of personal responsibility for the work. Regardless of whether the deployments are short or long staff should feel supported; whenever funding allows, turnover can be reduced if deployments are planned strategically and staff trained and motivated.
 
Community Based Volunteers

If the programme strategy is to work with community volunteers, the affected community should select them according to agreed, specific criteria. Existing outreach systems can be identified - they can also be mobilised more quickly. It is critical, however, that these outreach systems are respected and accepted by the community. Alternative systems for outreach such as Community Health Clubs F.1 may also be appropriate.

Ideally, community-based volunteers would be:

• From the same broad cultural background and ethnicity as the community with whom they work
• Motivated to work to improve the community and able to commit sufficient time for activities
• Respected and trusted within the community and a positive role model
• Have strong social and verbal communication skills and strong participatory facilitation skills
• Have an open and positive attitude to diversity and inclusion
• Have active listening skills, empathy and the confidence to work with groups and communities

The competencies expected of community-based volunteers vary. Some agencies demand literacy and numeracy, but this may exclude talented communicators and mobilisers in communities with low overall literacy rates or where women or persons with disabilities have not had the opportunity to attend school. Volunteers with disabilities are often more aware of the challenges faced in accessing and using water and sanitation information and facilities and in managing their personal hygiene (with or without the help of others). Organisations may differ in their staff and volunteer policies e.g. some may require that volunteers be insured or wear a particular uniform.

Volunteers make a significant contribution to the response; they need to be trained and well supported. They also bring their own beliefs, ideas and experiences to the work, which may include biases, misconceptions and prejudices against certain individuals or groups. Through formal and on-the-job training, practice, mentoring and continuous encouragement, volunteers can develop as open-minded facilitators rather than information providers or didactic teachers. 

Compensation for volunteers is often a source of debate and disagreement in emergencies, especially when volunteers are from the affected population and have no other source of income. The term ‘volunteer’ means that people do not normally receive payment but can be compensated in kind through the provision of training, materials and equipment and the respect of the community they are working for. Expenses for travel or meals when working can also be provided. The argument against paying volunteers is that it is not sustainable. However, it is often unrealistic in an emergency to expect people to work for more than a few hours a week for free. Compensation arrangements should therefore be context-specific, discussed and clarified in interagency meetings P.9 and discussed with community members before work commences.
 
Capacity Strengthening

Capacity strengthening can take place at an organisational, (inter)sectoral or community level. It aims to strengthen knowledge, skills and behaviour to enable people and organisations to effectively address WASH needs and increase their resilience to future crises. For the same reason, DRR and preparedness should incorporate capacity strengthening. Training and learning must support the development of key hygiene promotion competencies and be based on job descriptions. 

The community-based work of hygiene promoters may require training in facilitation and communication skills, including active listening, community participation and accountability. They will also require training in the specific tools and approaches used by an organisation.Embedding community engagement in a programme will also require managers, water and sanitation engineers, logisticians and others involved in the response to be trained. 

A competency framework (see Human Resources above) and a capacity strengthening plan should be developed, based on a learning needs assessment. Capacity strengthening is a continuous process; one-off training sessions or ‘workshops’ are insufficient. Each plan must be monitored and evaluated to ensure that it is achieving its aims. There are various methods for supporting capacity and learning other than classroom or workshop-based training. Learning by doing and using participatory exercises in the field provide practical experience. Coaching and mentoring are also ways to build capacity, as are one to one and group meetings. 

Opportunities for formal staff development may be limited in the first phase of response, but induction and on-the-job training should be provided as a minimum. Staff and volunteers can also be encouraged to set their own objectives for development and training. A coaching system for staff that ensures that they are continually trained, supervised and monitored can be useful.

Joint training sessions can be organised at an interagency level and should be a mixture of on-the-job and classroom based. On-the-job training is more likely in an acute emergency phase, concentrating on the specific activities that are required immediately. Training of trainers in the community can be useful, but all trainers should develop good training and facilitation skills - in reality, there is often a loss of quality when ‘cascading’ training from ToT level down to the community.

Regular meetings with teams of staff and volunteers are beneficial. They provide a chance for team members to learn from each other, discuss progress and field-related problems as well as strategies for managing them, changing and adapting action plans where required.

Budgets for training, capacity strengthening, monitoring and supervision must be written into proposals.
 
Human Resources and Adult Learning

Effective training provides adults with an opportunity to build on existing beliefs, knowledge and skills and to share them. Respect and relevance are critical to effective adult learning and adults need to feel that the learning is of immediate practical benefit. Learners must feel that their existing knowledge is recognised and that they are being listened to. Learning should bolster their self-esteem and never feel belittling or humiliating. Learners must be able to identify how they can use new knowledge, skills and attitudes immediately rather than in the future. It is said that adults retain 20% of what they hear, 40% of what they see and hear and 80% of what they do and discover. The best way to develop participants’ confidence, skills and self-esteem is to create opportunities for them to practise new skills and knowledge (e.g. role plays or going into the community to practise).

The role of the ‘trainer’ is to facilitate learning and to understand how to meet the different learning needs of the group by using a variety of methods and approaches. Didactic training methods that simply aim to supply information should be avoided in favour of developing critical thinking and reflection and the practical application of what is learned.

Hygiene (deriving from the Greek word ‘hygieinos’ which means healthful or relating to health) is a general term referring to conditions and practices of individuals and communities that help to maintain health and prevent the spread of diseases. Hygiene includes the preservation, promotion and strengthening of health and is interrelated with concepts of dignity, wellbeing, self-care, religion/spirituality and social participation, all of which play an important role in programming (e.g. to understand social norms about hygiene).

Hygiene Promotion in Emergencies is a planned, systematic approach that enables people to take action and encourages behaviours or conditions that prevent or mitigate WASH-related diseases. Hygiene promotion aims to support the dignity and wellbeing of emergency affected populations and no WASH intervention should be undertaken without including it. According to the Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response, hygiene promotion is intertwined with community engagement and ‘is fundamental to a successful WASH response’. Community engagement connects the community and other stakeholders so that people affected by the crisis have more control over the response and its impact on them. It should be supported by all involved in the response including government, local or international agencies and non-governmental organisations (NGOs). In recent years hygiene promotion has also played a key role in outbreak response, addressing not only WASH-related diseases but, in line with the original Greek concept of ‘hygieinos’, focusing on maintaining health and preventing disease more broadly, for example in responding to Ebola and COVID-19. 

With the adoption of the 2030 Agenda for Sustainable Development the ‘leave no one behind’ principle has been widely adopted in the WASH sector to ensure that the most vulnerable populations have access to basic needs and is therefore an important part of hygiene initiatives. Hygiene promotion recognises the differences within any population and the necessity to respond in various ways to the different WASH needs of women and men, girls and boys of different ages from different backgrounds, with different cultural and social norms, beliefs, religions, abilities, gender identities or levels of self-confidence and self-efficacy. 

Hygiene promotion’s emphasis on the importance of listening to affected communities and its use of dialogue and discussion provide a practical way of facilitating participation and accountability. It gives people a voice and involves them in making decisions about the way the programme is delivered (e.g., about the design, siting, operation and management of WASH facilities). 

Hygiene promotion should aim to understand the enablers and barriers to behaviour change so that programmes do not just focus on the provision of information and increasing knowledge but on working supportively with communities to understand how change can best be achieved. Hygiene promotion may therefore also consider other determinants of health and hygiene such as socio-economic, environmental and psychological barriers and enablers.

The following list describes key hygiene behaviours that a WASH programme can address. Please note: It is not intended as a list of topics to cover in hygiene promotion programming - a context-specific assessment and the involvement of community members in designing the response is always necessary. 

Hand Hygiene is a general term referring to any action of cleaning one’s hands with soap and water (or equivalent materials such asalcohol-based hand sanitiser) to remove pathogens like viruses, bacteria and other micro-organisms as well as dirt, grease or harmful and unwanted substances which are stuck to the hands. Handwashing with soap is regarded as one of the simplest and most effective ways to prevent the spread of diseases and respiratory infections. The key critical times for handwashing with soap should always be promoted: after using the toilet or cleaning a child’s bottom and before preparing food, eating and feeding a child. 

In health care settings, hand hygiene should be promoted at five points: (1) before touching a patient and (2) before performing cleaning procedures and after contact with (3) the patient, (4) body fluids (or risk of contact) and (5) their surroundings. In the case of COVID-19, patients are also expected to wash hands with soap at the point of entry to the health care facility (with handwashing facilities provided at all points of entry).

There are other times when handwashing with soap is highly recommended (e.g., after touching animals, garbage or blowing the nose), but it is important to avoid promoting too many actions at once. The focus should be on the most critical hand hygiene behaviours with the biggest health impact first. 

Handwashing technique is also very important. It includes wetting the hands with clean water, lathering the hands (including thumb, back of the hands, wrist, between the fingers and under the nails) by rubbing them with soap, scrubbing hands for at least 20 seconds, rinsing the hands under clean water and drying them either with a clean towel, on clean clothes or by air drying. 

Handwashing frequency is important too, as evidence indicates that washing hands more frequently, even if for shorter durations, may be more effective and may have an influence on hygiene promotion interventions (e.g. making handwashing as easy and convenient as possible). 

Even though handwashing is a simple activity, its promotion faces substantial challenges as regular handwashing is difficult to maintain for many users. This is especially so in contexts where running water, soap and/or handwashing facilities are not available or easily accessible. 

Behaviours related to Sanitation (where the term ‘sanitation’ mainly describes human excreta management) refer to access to adequate and inclusive sanitation facilities and a set of behaviours associated with safe excreta management. It includes the use, by all, of sanitation facilities at all times. It also refers to the routine operation and maintenance (O&M) of toilets which include all activities needed to run a sanitation scheme to increase efficiency, effectiveness and sustainability. It requires the assignment of clear roles and responsibilities (e.g., for cleaning, the replacement of consumables, small repairs or occasional checking of pits and fill up rates). Sanitation-related behaviour also includes the correct use of culturally appropriate anal cleansing materials, the safe collection, management, treatment and disposal of faeces (see also Compendium of Sanitation Technologies in Emergencies), the safe disposal of baby and child faeces, the use of items like potties or diapers if used (including effective cleaning or disposal), the use of incontinence materials and facilities and toilet training for children. It may also include the prevention of indiscriminate/open defecation and the potential clean-up of an already contaminated environment e.g., in the acute phase of an emergency if no toilets are available. It always implies handwashing after toilet use and after contact with children’s excreta (see also hand hygiene above). When sanitation technologies are introduced that are new to the affected population, sanitation-related behaviours may need to change. 

Water-Related Behaviours refer to access to adequate and inclusive water supply facilities, safe water management and all behaviours needed to ensure that the clean water provided at the point of supply (e.g., a communal borehole) remains uncontaminated until the point of use. It starts with the protection of the water source (such as keeping the area around the water source clean and fencing the source to prevent animals from entering) drainage of wastewater around taps and wells, maintenance of the installation and avoiding indiscriminate defecation around (and particularly upstream of) the water source. Water-related behaviours also include the safe transport of the water in clean, closed containers (e.g., jerricans) and the regular cleaning of the water containers. If further treatment at the household level is needed (see also Compendium of Water Supply Technologies in Emergencies), it may require the establishment (or reinvigoration) of habits and behaviours to ensure the correct use and maintenance of household water treatment options (e.g. household sedimentation, filtration or disinfection technologies such as ceramic filters, point of use chlorination, solar disinfection, or boiling of water). In addition, safe water storage at the household level must be ensured. That includes keeping water safe from (re-)contamination while it is being stored by protecting it from contact with hands, cups/dippers, animals, dirt and pathogens in the environment. It also includes the use of water storage devices with a fixed and lockable cover and a tap or a narrow neck that stands securely and is easy to handle. It may also require (community-led) water quality monitoring at regular intervals.

Menstrual Health and Hygiene Related Behaviours refer to inclusive access to facilities that support Menstrual Hygiene Management (MHM), the use of appropriate menstrual products and MHM awareness and education. It includes access to and use of clean and culturally-appropriate menstrual management materials for women and adolescent girls to absorb or collect menstrual blood and access to underwear. It also refers to a privacy requirement for changing materials as often as necessary for the duration of a menstrual period and to wash as needed. Access to safe and convenient facilities to dispose of used menstrual materials and to launder and dry them is essential; the disposal of menstrual waste must be managed effectively (e.g., using incinerators). Awareness and education about MHM are necessary to counter related beliefs, restrictions, taboos and misinformation and the access to basic information about the menstrual cycle (both for women and girls and men and boys) is important. Menstrual hygiene related behaviours may also include pain management through exercise, nutrition, comfort or use of pain medication (if needed) to enable continued participation in daily life. 

Food Hygiene Behaviours (or food safety) refer to the conditions and practices that prevent food contamination and corresponding food-borne illness. It includes the safe handling, storage and preparation of cooked and uncooked food prior to consumption at home, or in public places such as communal kitchens and canteens. Safe handling and preparation include maintaining a hygienic food preparation or processing environment, working with clean hands, washing and safe cooking or reheating of food. Stored food should be covered and protected from flies. Drinking vessels and cooking utensils should be clean when used and covered when stored (both in households and by food vendors). Infant feeding practices are particularly important: food hygiene encompasses safe and appropriate infant and young children feeding practices including breastfeeding. If infants are formula-fed (and this practice cannot be changed) a hygienic environment and the use of safe water for preparing the formula should be ensured. Unsanitary living conditions and associated diseases are directly linked to undernutrition, stunting, lowered immunity and increased risk of morbidity and mortality, especially amongst children under five years old. 
Personal Hygiene Behaviours refer to maintaining the cleanliness of the body and clothing to preserve overall health and wellbeing. It includes regular washing and bathing with soap to enhance a sense of wellbeing and to remove potential pathogens, dirt and bacteria that cause body odour or skin irritations. It can refer to dental hygiene such as regular tooth brushing, male genital hygiene where it is an issue (the impact of this can be debilitating – especially in challenging environments), regular handwashing with soap or washing clothing and bedding. Privacy, dignity and safety related to personal hygiene are important requirements. 

Environmental Hygiene and Behaviours Related to Solid Waste Management refer to all behaviours that ensure a clean and safe household and community environment. It includes waste collection, transport and disposal, drainage, potential site improvements and vector control measures (see next paragraph below). In areas with open defecation or free-roaming animals, environmental hygiene can have a significant impact on public health and especially for small children, who are in frequent contact with the ground. 

Behaviours Related to Vector Control refer to all behaviours and control measures that help prevent disease-carrying organisms (such as mosquitoes, fleas, flies or rodents) that transmit pathogens from wild or domestic animals, plants or the environment to humans. Malaria, dengue, scabies or diarrhoea are all examples of vector-borne diseases. Depending on the context and the corresponding risk behaviours, vector control may include the use of (insecticide-treated) bed nets, tents or curtains, wearing of long-sleeved clothing, regular washing of bedding and clothing, use of repellents, household fumigants, burning coils or aerosol sprays or avoiding being outside when vectors like mosquitoes are most active. The term can encompass other behaviours described above such as adequate personal hygiene, food hygiene, human or animal excreta management, environmental hygiene and waste management. Other measures and behaviours that contribute to the control of vectors include the removal of stagnant water sites (e.g., puddles, cans, tyres) and avoiding entering water where there is a known risk of contracting diseases such as schistosomiasis, guinea worm or leptospirosis. 

Behaviours Related to Specific Diseases refer to behaviours relevant to control e.g., epidemics or pandemics such as cholera or COVID-19. Behaviours include hand hygiene (see above), physical distancing, wearing of personal protective equipment (e.g., face masks, boots, gloves and clothing), disinfection, avoiding touching one’s face with unwashed hands and coughing/sneezing etiquette (coughing or sneezing into the elbow or a tissue and washing/sanitising hands afterwards) and caring for sick people at home. Other behaviours described above may also be included, such as personal hygiene, food hygiene and human or animal excreta management as well as the collection, transportation, storage and consumption of clean and safe water, environmental hygiene and waste management.

Hygiene Away from Home refers to all hygiene behaviours practised beyond the immediate household environment, such as in institutions (e.g., schools, health care facilities, workplaces and prisons) or other public settings such as transport hubs, places of worship, markets, restaurants or displacement and transit settings. It also refers to the access and use of basic WASH services in each location, effective hand hygiene at critical times and, depending on the setting and the time away from home, various behaviours described above (such as sanitation and water-related behaviours, environmental hygiene, solid waste management /or personal hygiene). 

There are several standards and guidelines for HP in emergencies, including the Sphere Handbook: Charter and Minimum Standards in Humanitarian Response, UNHCR’s WASH Manual for Refugee Settings, World Health Organization (WHO) guidelines (e.g. for hand washing hygiene) and national standards and guidelines. This section describes the Sphere Handbook (referred to hereon simply as ‘Sphere’) in detail as it is the main, globally agreed reference for WASH principles and standards.

Whatever the balance between national capacity and international support mobilised in response to a crisis, all parties must respect and observe the national regulatory environment. This includes relevant national policies, laws and standards. Local regulations at the municipal level are unlikely to be familiar to external actors but must be understood and adhered to. This is of particular importance when transitioning to longer-term solutions during the stabilisation and recovery phases.

However, national hygiene standards may not exist or be easily adapted to crisis situations. In these cases, Sphere should be referred to for guidance and/or UNHCR’s WASH indicators and targets for refugees and adapted based on the context, response phase and existing national targets. Whenever possible, government stakeholders should be engaged in the discussion about the application of emergency standards and indicators. 
 
The Sphere Handbook
Sphere provides a set of globally agreed and universal principles and standards in core areas of humanitarian assistance. With its rights-based and people-centred framework, Sphere aims to improve the quality of assistance provided to people affected by disasters and to enhance the accountability of the humanitarian system in disaster response. Sphere is a practical translation of its core belief that all people affected by disaster have the right to life with dignity and the right to receive humanitarian assistance. It consists of both foundation and technical chapters (see figure below). The Foundation Chapters include the Humanitarian Charter as its backbone with common legal principles and shared beliefs, the Protection Principles and the Core Humanitarian Standard that defines nine commitments applicable to all humanitarian actions. The Technical Chapters outline response priorities in four key life-saving sectors: WASH, food security and nutrition, shelter and settlement and health. These technical chapters must be read in conjunction with the Foundation Chapters.

In the technical chapters, standards state the minimum to be achieved in any crisis for people to survive and re-establish their lives and livelihoods in ways that respect their voice and ensure their dignity. These standards are universal, general and qualitative. Key actions outline practical steps for attaining the standard, though these are considered to be context-specific suggestions. In addition, indicators are outlined for each standard; they signal whether it is being met. Indicators also provide a way to compare programme results over the life of the response. Minimum quantitative requirements (where provided) are the lowest acceptable level of achievement and are only included where there is sectoral consensus. Guidance notes provide additional information on how to link the standards with the principles and how to consider context and operational requirements.
 
The hygiene promotion standards should be used in conjunction with the standards for the whole WASH chapter. They include many promotive and preventive measures enabling individuals and communities to exercise their human right to life in dignity. These rights are translated into three specific hygiene promotion standards entitling everyone to access the means to reduce public health risks and enable hygiene, health, dignity and well-being as outlined below. 
 
The Sphere Hygiene Promotion Standard 1.1 (Hygiene Promotion)

Minimum Standard: People are aware of key public health risks related to water, sanitation and hygiene, and can adopt individual, household and community measures to reduce them.

Key Actions:

1. Identify the main public health risks and the current hygiene practices that contribute to these risk.
   • Develop a community profile to determine which individuals and groups are vulnerable to which WASH-related risks and why.
   • Identify factors that can motivate positive behaviours and preventive action.
2. Work with the affected population to design and manage hygiene promotion and the wider WASH response.
   • Develop a communications strategy using both mass media and community dialogue to share practical information.
   • Identify and train influential individuals, community groups and outreach workers.
3. Use community feedback and health surveillance data to adapt and improve hygiene promotion.
   • Monitor access to and use of WASH facilities, and how hygiene promotion activities affect behaviour and practice.
   • Adapt activities and identify unmet needs.

Key Indicators:

• Percentage of affected households who correctly describe three measures to prevent WASH-related diseases
• Percentage of target population who correctly cite two critical times for handwashing
• Percentage of target population observed to use handwashing stations on leaving communal toilets
• Percentage of affected households where soap and water are available for handwashing
• Percentage of affected population who collect water from improved water sources
• Percentage of households that store drinking water in clean and covered containers
• Percentage of carers who report that they dispose of children’s excreta safely
• Percentage of households using incontinence products (pads, urinal bottles, bed pans, commode chairs) who report that they dispose of excreta from adult incontinence safely
• Percentage of affected households who dispose of solid waste appropriately
• Percentage of people who have provided feedback and say that their feedback was used to adapt and improve WASH facilities and services
• Local environment is free of human and animal faeces

The Sphere Hygiene Promotion Standard 1.2 (Identification, Access to and Use of Hygiene Items)

Minimum Standard: Appropriate items to support hygiene, health, dignity and well-being are available and used by the affected people.

Key Actions:

1. Identify the essential hygiene items that individuals, households and communities need.
   • Consider different needs of men and women, older people, children and persons with disabilities.
   • Identify and provide additional communal items for maintaining environmental hygiene, such as solid waste receptacles and cleaning equipment.
2. Provide timely access to essential items.
   • Assess availability of items through local, regional or international markets.
3. Work with affected populations, local authorities and other actors to plan how people will collect or buy hygiene items.
   • Provide information about timing, location, content and intended recipients of cash-based assistance and/or hygiene items.
   • Coordinate with other sectors to provide cash-based assistance and/or hygiene items and decide on distribution mechanisms.
4. Seek feedback from affected people on the appropriateness of the hygiene items chosen and their satisfaction with the mechanism for accessing them.

Key Indicators:

• All affected households have access to the minimum quantity of essential hygiene items:
  • two water containers per household (10–20 litres; one for collection, one for storage);
  • 250 grams of soap for bathing per person per month;
  • 200 grams of soap for laundry per person per month;
  • Soap and water at a handwashing station (one station per shared toilet or one per household); and
  • Potty, scoop or nappies to dispose of children’s faeces.
• Percentage of affected people who report/are observed using hygiene items regularly after distribution
• Percentage of household income used to purchase hygiene items for identified priority needs

The Sphere Hygiene Promotion Standard 1.3 (Menstrual Hygiene Management and Incontinence)

Minimum Standard: Women and girls of menstruating age, and males and females with incontinence, have access to hygiene products and WASH facilities that support their dignity and well-being.

Key Actions:

1. Understand the practices, social norms and myths concerning menstrual hygiene management and incontinence management, and adapt hygiene supplies and facilities.
2. Consult women, girls and people with incontinence on the design, siting and management of facilities (toilets, bathing, laundry, disposal and water supply).
3. Provide access to appropriate menstrual hygiene management and incontinence materials, soap (for bathing, laundry and handwashing) and other hygiene items.
   • For distributions, provide supplies in discrete locations to ensure dignity and reduce stigma, and demonstrate the correct usage for any unfamiliar items.

Key Indicators:

• Percentage of women and girls of menstruating age provided with access to appropriate materials for menstrual hygiene management
• Percentage of recipients who are satisfied with menstrual hygiene management materials and facilities
• Percentage of people with incontinence that use appropriate incontinence materials and facilities
• Percentage of recipients that are satisfied with incontinence management materials and facilities

Hygiene promotion interventions differ according to the context, including the phase of an emergency. Common categories used to distinguish phases are (1) acute response, (2) stabilisation and (3) recovery. Additional longer-term phases that may need to be taken into consideration are (4) protracted crisis and (5) development. The identification of these broad phases is helpful when planning assistance, whilst recognising that the division is theoretical, offering a simplified model of a highly complex emergency situation. 

Acute Response: this usually covers the period from the first hours and days up to the first few weeks or months, when rapid, short-term measures are implemented until more permanent or durable solutions can be found. Rapid humanitarian relief interventions are made immediately following natural disasters, conflicts, epidemics/pandemics, or further degradation of a protracted crisis. The purpose of interventions in the acute response phase is to secure and ensure the survival of the affected population, guided by the principles of humanity, neutrality, impartiality and independence. It usually takes time for external support agencies to mobilise; those affected typically have to deal with the emergency initially themselves - even though they may not be adequately prepared.

An initial (rapid) assessment (chapter  A ) identifies the acute public health risks, priority needs and leads to a better understanding of the context, community profile, available capacity and current hygiene-related practices. Hygiene promotion actions must also facilitate intersectoral and cross sector communication and coordination with all relevant stakeholders. It must enable the involvement of local hygiene promoters and community mobilisers (chapter  P ). To ensure that the response includes the entire affected population, hygiene promotion makes sure that local authorities and local first responders are involved from the outset and that there is equitable participation of men, women, children and marginalised and vulnerable groups in planning, decision-making and local management (chapter  E ). These consultations may also inform the initial provision of basic WASH infrastructure (primarily on a communal level to reach many people quickly), access to relevant hygiene items (such as soap, buckets, or menstrual products) as well as measures to ensure a hygienic and safe environment (chapter  P ). Depending on the context it may also involve the use of different participatory or mass media communication tools (chapter  C ) and targeted behaviour change strategies (chapter  B ) to address the most critical hygiene behaviours. 

Stabilisation: the stabilisation or transition phase usually starts after the first weeks/months of an emergency and can last six months or longer. The main focus, as well as increasing service coverage and an incremental upgrade and improvement of temporary structures,is to enable people to practice basic hygiene-related behaviours and ensure their active participation and engagement. During the stabilisation phase, relevant pre-emptive resilience and DRR measures should be implemented, particularly if another disaster is likely. The equitable participation of men, women, children, marginalised and vulnerable groups in planning, decision-making and local management (chapter  E ) remains as important as in the acute phase. Participation helps to ensure that the entire affected population has safe and adequate access to WASH services and practises key hygiene behaviours.

Additional in-depth assessments of the factors underpinning behaviour may be needed (chapter  A ) to respond adequately within a given local context and increase the longer-term acceptance of the planned interventions. Monitoring the effectiveness of initial interventions should also lead to adaptations and improvements (chapter  M ). Hygiene promotion interventions may include the establishment of additional community-supported structures (chapters  P  and  E ) and, where possible, the increasing involvement of development actors. The scope for using Market-Based Programming P.8) should also be examined. 

Recovery: the recovery phase, sometimes referred to as the rehabilitation phase, aims to recreate or improve the pre-emergency situation of the affected population by increasingly incorporating development approaches and principles. This phase usually starts after, or sometimes during, relief interventions (usually >6 months) and can be viewed as a continuation of completed relief efforts. Overall, it can prepare the ground for longer-term development interventions and for handing over to medium-long-term partners. Depending on local needs, the general timeframe for recovery and rehabilitation interventions is usually between six months and three years. Difficult and complex situations, such as in conflict-affected areas, may need much longer and can move in and out of crisis (see Protracted Crisis below). 

Recovery and rehabilitation programmes are characterised by the active participation of local partners and authorities in planning and decision making, strengthening local capacity and promoting the sustainability of interventions. The scope for using Market-Based Approaches P.8 should be further assessed here. Hygiene promotion recovery interventions vary; they continue to depend on local conditions as well as the affected population’s immediate and structural needs (e.g. promoting gender equity and human rights). Beyond the technical implementation of relevant WASH infrastructure, these interventions include significant efforts to strengthen WASH service structures and systems as a whole. 

Recovery interventions also include longer-term capacity strengthening and training, including working with relevant local authorities and development partners. Stronger collaboration with utilities, civil society, private sector and the handing over of responsibilities is important and requires the increasing participation of stakeholders in planning and decision-making early on (chapter  E ). Where possible, recovery interventions should provide a foundation for further development of WASH facilities and services and include relevant resilience and DRR measures. Effective recovery plans have clear transition or exit strategies, including hand-over to local governments, communities or service providers to ensure that the intervention’s service levels can be maintained.

Protracted Crisis: refers to populations affected by recurrent disasters and/or conflicts, prolonged food crises, the deterioration of people’s health and a breakdown of livelihoods. In these environments, a significant proportion of the population can become acutely vulnerable to a prolonged increase in mortality and morbidity rates. Protracted crises often occur in already fragile environments (see Fragile States above), where the state is unwilling or unable to fulfil its basic functions and to manage, respond to, or mitigate risks. The context may cause social tensions (e.g. between refugees or internally displaced people and host communities). It may then be necessary to explore complementary and alternative approaches to WASH service provision, mainly working at a more decentralised level with non- and sub-state actors. Even if funding is (commonly) more constrained in a protracted crisis, hygiene promotion needs, at a minimum, to ensure community engagement in all WASH service provision.

Development: the development phase is characterised by a stronger focus on universal access and the longer-term sustainability of WASH services, with global targets set by the Sustainable Development Goals. As well as improving access to WASH services, development aims to strengthen the local, regional or national WASH systems as a whole, including all actors (people and institutions) and factors (e.g. infrastructure, finances, policies, coordination and environmental conditions) needed to deliver sustainable WASH services. Hygiene promotion interventions in the development phase can have various forms and objectives, depending on the local conditions and the needs of the target population. Interventions often revolve around creating demand for and ensuring the use, operation and maintenance of WASH services, longer-term behaviour change and habit formation, ownership and empowerment. 

In disaster and crisis-prone regions, preventative measures such as DRR, preparedness and Climate Change Adaptation activities should be considered and addressed during the development stage. Such interventions aim to reduce disaster risks through systematic efforts to analyse and reduce the causal factors of disasters and to take precautionary measures. They also aim to strengthen the ability of governments, organisations and the affected population to mitigate risks and to respond promptly. 

Key hygiene promotion measures include working with national clusters or sector coordination mechanisms to develop standard operating procedures, agree on local standards for hygiene promotion and hygiene items and develop contingency and emergency preparedness plans. Development hygiene promotion can include the stockpiling of WASH equipment and consumables, the preparation of emergency services and stand-by arrangements (with a clear assignment of responsibilities and jurisdiction) as well as the establishment of support networks among different regions. It also includes capacity strengthening and training of volunteers and emergency personnel and the strengthening of local structures through community planning and training. It may include pre-crisis market assessments, operational research and/or compilation of information on, for example, hygiene practices, risk perceptions and trusted communication channels that can be rapidly used in a new emergency.