WHO defines a ‘setting’ as ‘the place or social context in which people engage in daily activities in which environmental, organisational and personal factors interact to affect health and wellbeing. A setting is also where people actively use and shape the environment and thus create or solve problems relating to health.’

A settings-based approach recognises the potential of places where people gather together and aims to understand and make use of the social norms and hierarchies associated with being part of that group setting B.6.

The most common approach to hygiene promotion (HP) in emergencies involves training networks of outreach workers to visit people in their homes and/or school settings. But there is a variety of community settings that offer both WASH risks and opportunities for engaging with the community and motivating them to improve hygiene. 

Markets for food and other commodities often spring up to meet the needs of refugees or displaced people, but may not be regulated or have public WASH facilities such as toilets and handwashing stations. Canteens or community kitchens and food distribution points may also be places where hygiene provision can be improved. Hospitals, clinics, care homes and crèches may have some WASH facilities, but lack cleaning regimes or adequate supplies of consumables such as soap. A WASH assessment should be carried out in all of these locations. Settings can also provide opportunities to discuss hygiene and provide information to different groups of people. Beauty parlours and barbers have also been used to good effect as locations for health and HP in various countries.

Women’s groups, self-help groups, disabled people’s organisations, elders’ groups or youth groups may have existed pre-emergency and can be easily reconvened or initiated. Clubs can also be started or re-started for sports or other pastimes and used as entry points for health and HP. Religious settings, such as churches, temples or mosques, are also important gathering places in a community; hygiene can be promoted to different groups by working with religious leaders.

Strengthening community groups and organisations through a common purpose can unite the capacity of the disparate communities found in some emergencies and motivate people to work together to improve hygiene.

Process & Good Practice

• Find out how a particular setting is organised, the leadership, hierarchy, behaviour and social norms B.6 expected of different members - and how the emergency has influenced them. Identify what makes a given social setting differ from others through questions and discussions with members.

• Identify the specific hygiene needs and problems in that setting and what members think can be done about them. How do members understand the influences on hygiene and health and how relevant are they to them?

• Find out who is influential in this setting and who sets the agenda. Work through them initially but find ways to enable the less influential to participate. 

• Understand how different settings can influence and interact with each other e.g. relationships between youth groups and schools or religious institutions and community kitchens. 

• Be aware that each hygiene promoter will bring specific qualities to each setting; they can cause friction and/or develop affinities depending on their skills, capacities and background and language. For example, some older women may find it difficult to talk to teenage girls and a woman might not be accepted in a male barber shop. Consider reassigning staff to different settings if appropriate.

• Explore how the setting itself can promote hygiene more broadly as well as encourage members to adopt specific hygiene behaviours. For example, the setting may encourage handwashing but also support collaborative group action to influence others or to develop policies, regulations, systems and facilities.

• Give the group a key role in making decisions about strategy, plans and activities. In any setting, different levels of engagement can apply, but the surest way to make progress is to be as participatory as possible.

• Define indicators of success with the group and explore with them how these will be measured.