ICRC WASH

IFRC
WASH guidelines for hygiene

promotion in emergency
operations
www.ifrc.org
Saving lives, changing minds.
© International Federation of Red Cross
and Red Crescent Societies, Geneva, 2017
Copies of all or part of this manual may be made for

noncommercial use, providing the source is acknowledged
The IFRC would appreciate all request being directed to the IFRC WASH GUIDELINES FOR HYGIENE PROMOTION
IFRC at secretariat@ifrc.org. IN EMERGENCY OPERATIONS
1319400 10/2017 E
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IFRC
WASH Guidelines for hygiene
promotion in emergency operations
The guidelines assist Red Cross Red Crescent staff groups, the barriers and motivators for behaviour
and volunteers to work systematically in deliver- change by involving the community at all stages
ing hygiene promotion in emergencies, start- and ensuring the response is effective and appro-
ing with understanding the problem and target priate to the needs.
International Federation of Red Cross and Red Crescent Societies
Table of contents WASH guidelines for hygiene promotion in emergency operations
Table of contents
List of Acronyms 4
List of Figures 5
Introduction 6
Who is this document for? 8
What is Hygiene Promotion and why is it important
in emergencies? 8
How to implement Hygiene Promotion in emergencies? 16
Step 1: Identifying the Problem20

Step 2 : Identifying Target Groups28
Step 3: A nalysing Barriers and Motivators
for Behaviour Change32
Step 4: F ormulating Hygiene Behaviour Objectives42
Step 5: Planning46
Step 6: Implementation64
Step 7: Monitoring and Evaluation74
Step 8 : Review, Re-Adjust82
References 84
Annexes 86
IFRC Guidelines to Hygiene Promotion- Quick fix 87
3
WASH guidelines for hygiene promotion in emergency operations
List of Acronyms
CHS Core Humanitarian Standard
CLTS Community-Led Total Sanitation
ERU Emergency Response Unit
HP Hygiene Promotion
IEC Information Education and communication
IFRC International Federation of Red Cross and Red Crescent
MHM Menstrual Hygiene Management
MSM Mass Sanitation Module
NDRT National Disaster Response Team
NFIs Non-Food Items
NS National Society
RCRC Red Cross Red Crescent
RDRT Regional Disaster Response Teams
WASH Water, Sanitation and Hygiene
PHAST Participatory Hygiene and Sanitation transformation
PoA Plan of Action
FGD Focus group discussion
4
Table of contents WASH guidelines for hygiene promotion in emergency operations
List of Figures
Figure 1: WASH Hygiene Improvement Framework
Figure 2: Hygiene promotion Project Cycle
Figure 3: Rapid Assessment
Figure 4: Assessment Methods
Figure 5: The F-Diagram Disease Transmission routes
Figure 6: Barrier Chart
Note
This Hygiene Promotion in Emergencies pack consists of the fol-
lowing.
1. IFRC Guidelines for Hygiene Promotion in Emergencies (this

document)
� This provides guidance on how to plan and implement hy-
giene promotion in emergencies with links for further infor-
mation
2. A 16-page summar y of the IFRC Guidelines to Hyg iene

Promotion in Emergencies
� A summary, which describes the outline, with a brief de-
scription of all the steps
3. A short one-page summary of the IFRC Guidelines to Hygiene

Promotion in Emergencies
� To give an overview (Annex)
4. A training manual to help put these IFRC Hygiene Promotion

guidelines for Emergencies into practice;
� With learning objectives and session plans that can be
adapted to the context.
5
Introduction
6
INTRODUCTION
Introduction WASH guidelines for hygiene promotion in emergency operations
Introduction
STEP 1
The aim of these guidelines is to ensure that all Red Cross (RC)
emergency water, sanitation and hygiene (WASH) programmes
include effective hygiene promotion (HP), which is relevant to the
context. The Red Cross, unlike many organisations is in a unique
STEP 2
position of having community based staff and volunteers, and is
well-placed to work with the community, which is essential in
hygiene promotion. However, experience has shown that during
an emergency response the approach generally focuses on ‘deliv-
STEP 3
ering’ hygiene promotion in the form of giving messages. These
guidelines assist RC staff and volunteers to work systematically,
working through all the important steps for planning, imple-
menting and monitoring hygiene promotion, starting with under-
STEP 4
standing the problem, the barriers and motivators for behaviour
change; with the community involved at all stages – listening and
working with the affected community, ensuring the response
is effective and appropriate to the needs. Although every situa-
tion is different, this approach with a clear pathway assists with
STEP 5
quality assurance, linking with agreed standards; assuring effec-
tive implementation, with monitoring and training appropriate to
the needs.
This document is summarised in a short six-page document and STEP 6

there is also a one-page (annex 1.2) overview document and a
training manual with suggested sessions for training on emer-
gency hygiene promotion linked with this document is produced.
All these documents and the links to tools, resources and refer-
STEP 7
ence material mentioned in the documents are linked and will be

available on the IFRC http://watsanmissionassistant.org.
STEP 8
7
Who is this document for?

This document is for all RCRC staff and volunteers responding to
an emergency; including community-based volunteers, NS staff,
NDRTs, RDRTs and ERUs, especially those working in the WASH
sector.
The specific target audience are hygiene promoters who may

have different levels of experience and capacity for an emergency
WASH response. The aim is for these guidelines and training ma-
terials to be used by all hygiene promoters in different situations;
providing guidance to those with limited experience and to be of
use to those with more experience who may work in situations
where experience and judgement are needed to adapt activities
for more challenging environments.
What is Hygiene Promotion and why is it important

in emergencies?
RCRC Definition of Hygiene Promotion in Emergency
Hygiene promotion (HP) in Emergencies in the Red Cross is defined as:

‘a planned, systematic approach delivered by RCRC staff and volun-
teers; to enable people to take action to prevent water, sanitation and
hygiene-related diseases by mobilising and engagement of the affected
population, their knowledge and resources; and to maximize the use and
benefits of water and sanitation items and facilities’.
The main aim of a WASH intervention is to prevent and reduce

WASH related disease transmission. Hygiene Promotion is an es-
sential part of a successful WASH intervention.
Health of individuals and communities are influenced by many

factors, such as the environment, socio-economic situation,
health systems and behaviour. It is essential to ensure that eve-
ryone has the means to be healthy rather than only focusing on
individual behaviour. Ensuring access to water, sanitation and
8
INTRODUCTION
hygiene facilities is part of hygiene promotion, along with influ-

encing attitudes to change behaviour.
STEP 1
An emergency situation can impact on health in different ways;
water sanitation and hygiene facilities may be limited, e.g. if
people are displaced living in temporary shelters, left their homes
(e.g. due to conflict, or a natural disaster), the infrastructure is
STEP 2
damaged (e.g. following earthquake, floods), there is a lack of re-
sources (e.g. soap), lack of health care facilities, lack of food, lack
of shelter, overcrowding etc.; all of which can make the risks for
water and sanitation related diseases increase.
STEP 3
Hygiene Promotion involves ensuring that optimal use is made
of the water, sanitation and hygiene facilities that are provided.
Previous experience has shown that facilities are frequently not
STEP 4
used in an effective and sustainable manner unless Hygiene
Promotion is carried out. Access to hardware (e.g. latrines,
drinking water and handwashing facilities) combined with an en-
abling environment and Hygiene Promotion make for hygiene im-
provement, as shown in the model of the Hygiene Improvement
STEP 5
Framework for Emergencies (Figure 1), The overall aim of hygiene
improvement is to prevent or lessen the impact of WASH related
diseases. Source: Hygiene Promotion in Emergencies, WASH
cluster briefing paper
STEP 6
The focus of hygiene promotion is determined based on
the public health risks. Normally the key issues to ad-
dress are:
STEP 7
Safe disposal of excreta

Effective hand washing
Reducing the contamination of household drinking
water
STEP 8
9
But it is not limited to these alone, other issues such as vector

control, waste management and menstrual hygiene management
should be included, depending on the need and context of the
disaster.
The key point is that the affected population are aware of the key
public health risks and are enabled to adopt safe hygiene prac-
tices and make the best use of WASH facilities and services (in-
cluding their operation and maintenance).
Figure 1: H ygiene Improvement Framework (Source: Sphere

handbook 2011)
The ‘campaign’ approach has been the most widely used method
for hygiene promotion in emergency in the Red Cross Red
Crescent. Campaigns have been structured following principles of
hygiene education, delivering educational activities in a prescrip-
tive and formal way, for example by standing in front of a group
of beneficiaries and explaining the Disease Transmission chart
(F chart) with a poster. Weak consideration has been showed on
how to engage those groups in activities that generate some level
or action. Using the same example, groups of women can discuss
10
INTRODUCTION
the F chart and agree on which barriers can be placed to break

the transmission routes in the F chart and helping them to put in
STEP 1
practice their ideas.
Key components of Hygiene Promotion are:

Community Consult with the affected men, women,
participation and children on the design of the facilities,
STEP 2
the hygiene kits and the outreach system,
identifying the vulnerable and working with
existing community structures
Use and Feedback to/from the engineers or com-
STEP 3
maintenance munity on design and acceptability of
of facilities facilities. It will encourage community
ownership and taking the responsibility of
cleaning and maintenance of facilities
Selection and Working with the community on the type
STEP 4
distribution of of hygiene items needed
hygiene items
Community Using principles of behaviour change

and individual communication, training community
STEP 5
action based volunteers as Hygiene Promoters,
organising community activities such as
dramas, and engaging individuals with
home visits
Communication Collaborate with Government, other or-

with WASH ganisations (both international and na- STEP 6
stakeholders tional) working in the area, participate in
coordination mechanisms, such as the
WASH cluster
STEP 7
Monitoring The use and the community’s satisfaction

to the programme and facilities
For more information on these points refer to the WASH Cluster

STEP 8
Hygiene Promotion briefing paper. All RC WASH programmes

should include all these components.
11
Principles and Standards

All RCRC Staff and volunteers involved in hygiene promotion ac-
tivities need to be familiar and adhere to humanitarian principles
and standards, including:
� The Red Cross Fundamental Principles
� The Red Cross Movement Code of Conduct
� The Standards in the Sphere handbook
� Community Engagement and Accountability (CEA)
Sphere handbook
The main aim of Sphere handbook1 is to improve the quality of
the humanitarian response in situations of disaster and conflict,
and to enhance the accountability of the humanitarian system to
disaster-affected people.
There are two standards for Hygiene Promotion in the Sphere

handbook (2011)2, which should be used with the key actions and
indicators.
Sphere Standard 1: Hygiene promotion implementation

Affected men, women and children of all ages are aware of key
public health risks and are mobilized to adopt measures to pre-
vent the deterioration in hygienic conditions and to use and
maintain the facilities provided.
Sphere Standard 2: Identification and use of hygiene items

The disaster-affected population has access to and is involved in
identifying and promoting the use of hygiene items to ensure per-
sonal hygiene, health, dignity and well-being.
As the Sphere handbook states Hygiene Promotion gives the af-

fected community an opportunity to get involved, ensuring that
1
ICRC, IFRC (2008) Guidelines for assessments in emergencies.
2
Sphere 2018 will be launch in the beginning of 2018
12
INTRODUCTION
the facilities are appropriate to the risks and the needs and are
therefore used appropriately.
STEP 1
Experience has shown that during an emergency response, the
RCRC has generally used the ‘campaign approach’, with the
emphasis on giving messages with Information Education and
Communication (IEC) materials, with the aim of changing be-
STEP 2
haviour. This approach is not effective if we do not work together
with the affected population to understand the problem, the mo-
tivators and barriers and to enable the community (individuals,
households and the wider community) to address the public
STEP 3
health problem together. Just increasing the knowledge of the
affected community may not change behaviours and attitudes-
they are not empty and ignorant people waiting to have informa-
tion poured into them.
STEP 4
Common Pitfalls in Hygiene Promotion
Several reports, reviews and guidelines have observed a variety of pitfalls
in hygiene promotion implementation
STEP 5
Too much focus on Not enough focus on
-- Dissemination of one-way messages -- Practical action that people can take

without listening to different groups and how to communicate
in the population -- How to address many behaviours
-- Designing promotional materials and audiences at the same time
such as posters and leaflets before
understanding the problem properly
-- Using motivators such as nurture, STEP 6
disgust and affiliation and the belief
-- Personal hygiene and not enough on that the promise of better health is
the use, operation and maintenance the key motivator
of facilities. -- Listening, discussions and dialogues
STEP 7
for people to clarify issues and work

out how to adapt required changes
to their specific situation.
Community mobilisation is especially appropriate during disas-

STEP 8
ters as the emphasis must be on encouraging people to take ac-

tion to protect their health. Promotion activities should include,
13
where possible, interactive methods rather than focusing exclu-

sively on the mass dissemination of messages (Sphere handbook,
2011). If the methods are interactive with all the community
(men, women, children, marginalised groups), with the opportu-
nity to share information, discuss and ask questions, there will
be more in-depth knowledge about what influences what people
think and do.
Accountability
It is important to acknowledge that our fundamental accounta-
bility must be to those we are assisting. All RCRC WASH activities
must emphasise: providing information, active listening to those
affected, respectful attitude and empathy to those who we assist.
The WASH cluster Accountability Project developed some simple

tools to help WASH fieldworkers understand the practical aspects
of accountability. Accountability is described as having five di-
mensions: participation, transparency, feedback mechanisms and
complaints, staff competencies and attitudes and monitoring and
evaluation.
It is strongly encouraged for hygiene promoters to read the booklet

as this suggests key activities for both the first acute phase and
the second phase/chronic emergency. The Accountability Booklet
elaborates on all of the dimensions of accountability. The key as-
pects of accountability to beneficiaries includes explaining and
taking responsibility on what you do and do not do, providing
accessible timely information, ensuring mechanisms are set up
for feedback and complaints and enabling the affected people to
make decisions on the WASH interventions.
The Core Humanitar ian Standard (CHS) on Qualit y and

Accountability sets out nine Commitments that the Red Cross can
use to improve the quality and accountability to communities and
people affected by crisis; the CHS places communities and people
14
INTRODUCTION
affected by crisis at the centre of the humanitarian action and

promotes respect for their fundamental human rights. It links to
STEP 1
the Red Cross Fundamental Principles of humanity, impartiality,
independence and neutrality. The CHS will be soon incorporated
in the Sphere handbook 2018.
STEP 2
Q: Is there any evidence that hygiene promotion in
emergencies works?
A: Whilst we may lack academic evidence to demon-
STEP 3
strate that hygiene promotion in emergencies works
(especially in acute emergencies) there is plenty of
anecdotal evidence. Hygiene promotion is not just
about behaviour change, e.g. getting people to wash
hands, it is also about getting people involved and
STEP 4
enabling them to take action, and it found that when
more people are involved and the programme be-
comes more effective.
STEP 5
STEP 6
STEP 7
STEP 8
15
How to implement Hygiene Promotion in emergencies?

To implement an effective hygiene promotion programme, with
a focus on safe disposal of excreta, effective hand-washing and
reducing the contamination of household drinking water; it is im-
portant to be systematic, and make a plan that enables people to
take action to prevent water, sanitation and hygiene related dis-
eases, addressing the needs (linked to the impact of the disaster),
and considering the barriers and motivators to behaviour change.
This can be challenging in an emergency response when the situ-
ation is often confusing and chaotic.
The implementation of the Hygiene Promotion programme fol-

lows a circular process, which begins with an assessment and
ends with a review. It is iterative process; feedback and lessons
learnt must be incorporated to ensure the programme is always
appropriate to the needs of the affected people. The intervention
process should look like this:
Figure 2: Hygiene promotion project cycle (Source: WASH Cluster,

Hygiene Promotion – A Briefing Paper)
16
INTRODUCTION
8 Steps for Hygiene Promotion

in Emergencies
STEP 1
A step by step process has been chosen to facilitate the imple-
mentation of hygiene promotion activities in emergency response
STEP 2
operations. The teams of hygiene promoters, either grass root
volunteers or/with RCRC staff will follow an eight-step process.
Volunteers and staff can follow an easy and structured path for
delivering basic hygiene promotion activities and managers and
STEP 3
/ or volunteers’ supervisors and team leaders can better support
and mentor their team by knowing which steps have been ac-
complished.
STEP 4
In summary, there are the 8 steps for hygiene promotion in emer-
gencies for the RCRC. These steps have some additional steps to
the project cycle on Figure 2. It is to make the process more related
to the RCRC disaster response style and to ensure accountability
to beneficiaries is achieved by having a participatory approach.
STEP 5
1. Identifying the problem
2. Identifying target groups
3. Analysing barriers and motivators for behaviour change
4. Formulating hygiene behaviour change objectives STEP 6
5. Planning
6. Implementation
7. Monitoring and evaluation
8. Review, re-adjust
STEP 7
These steps are described in more detail below, with links to ap-
proaches and tools. By completing the 8 steps hygiene promoters
in the Red Cross will be able to deliver hygiene promotion activi-
STEP 8
ties in a more structured and systematic way. At the end of step
17
5 (planning), the hygiene promotion team will have a systematic

behaviour change plan to implement. Campaigns will have clear
behaviour change objectives and promotional tools will be se-
lected according to the target group.
Depending on the context at the onset of the emergency, com-

pleting Step 1 to 5 may take from 7-10 days, using the informa-
tion available pre-disaster, the data generated through rapid
assessment and some specific information for consultation with
NS, community and key stakeholders. From week 2 of the emer-
gency response a first round of implementation (Step 6) and M&E
(Step 7) need to be executed to cope with major risks and needs.
Step 8 is certainly important in month 1 when the situation might
be becoming more stable so re-adjusting becomes crucial. At this
stage, it is important for hygiene promoters to understand the
need to come back to step 1 with more comprehensive assess-
ment (step 1-3) or ideally a baseline survey, followed by proper
planning process (step 4-5). These timings are all provisional and
provided for guidance only.
18
INTRODUCTION
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
STEP 6
STEP 7
STEP 8
19
STEP 1
IDENTIFYING
THE PROBLEM
INTRODUCTION
Step 1 Identifying the Problem
Step 1: I dentifying
the Problem
STEP 1
The aim of the assessment is to understand the
situation in order to identify the problem(s), the
STEP 2
source of the problem(s) and consequences of the
problem(s), the needs and capacities of the af-
fected population. “Whilst good information does
not guarantee a good programme, poor information almost cer-
STEP 3
tainly guarantees a bad one.”1
Although it is an emergency, the assessment should be planned:

consider the critical information that is needed, the sources of
STEP 4
this information and the data collection methods. An emergency
response is often chaotic; coordination can be difficult, if there
are lots of organisations, communication can be challenging if
the phone network/power supplies are not working. There may
be a lack of NS staff and volunteers – they may be affected by the
STEP 5
disaster themselves.
An initial rapid assessment is essential in the first couple of days

to highlight the priority interventions needed, more information
can then be added with a more in-depth assessment. STEP 6
Once the assessment is done, a baseline survey should be con-
ducted, to document the current situation, (see Step 5).
STEP 7
What Information?
A rapid assessment should provide information about:
Public Health situation
Community structure
STEP 8
1
ICRC, IFRC (2008) Guidelines for assessments in emergencies.
21
It should be as follow:
Safe drinking Water
Safe excreta disposal
hygiene practices & handwashing
Vector control
Waste management
Drainage
Menstrual Hygiene
Priority and vulnerable groups
The details of questions on these main areas can be found on the

sample Assessment form.
How?
The assessment should be done jointly with Hygiene Promoters,
WASH engineers and government officials, in collaboration and
coordination with the NS, RDRT, ERUs and other stakeholders;
e.g. WASH cluster partners and colleagues from other sectors,
e.g. Health, Shelter etc. The assessment team should include rep-
resentatives from the affected community, a balance of men/
women, staff/volunteers from the NS – who know, understand
and respect the culture of the affected community and have good
observational and listening skills. As hygiene promotion com-
bines insider/affected population knowledge (what people know,
do and want) with outsider knowledge (e.g. the causes of diar-
rhoeal diseases), it is essential to involve the affected population.
The assessment should use interactive participatory methods,

with all sectors of the community; men, women and children,
and different groups of people (and it is important not to leave
out marginalized, less visible vulnerable groups, including people
with disabilities), to gather information, and engage with the
community to identify the problem to help them find a solution.
The choice of the methods depends on the context, access, re-
sources and timing. It is useful to use a combination of methods,
22
INTRODUCTION
including quantitative data (e.g. number of available latrines per

population), and qualitative information (e.g. whether all the
STEP 1
people are using the latrines are satisfied with the design, loca-
tion etc.). It is important not to make assumptions: observe and
talk with people.
All data should be disaggregated by age and sex. Gender and
STEP 2
other social/cultural factors (including age, disability health
status, social status, ethnicity, etc.) shape the extent to which
people are vulnerable to, and affected by emergencies. Refer to
the IFRC Minimum standard commitments to gender and diver-
STEP 3
sity in emergency programme, to ensure that commitments to
dignity, access, participation and safety of the affected communi-
ties are addressed in the assessment, planning, implementation
and monitoring of the WASH programmes.
STEP 4
The assessment should consider all sections of the
community, not forgetting marginalised, less visible,
vulnerable groups.
STEP 5
Primary and Secondary Data
Primary data (collected as part of the assessment) must be rel-
evant: e.g. an understanding of hygiene behaviour and changes STEP 6
in behaviour. Do not collect information that is already available
– it wastes time, resources and can be annoying to a community
that has many needs and feel they are constantly being asked the
same questions. Collect secondary data from a variety of sources:
STEP 7
the NS (staff and volunteers), WASH cluster, local Government

Agencies and local NGOs. Triangulate all the information, com-
paring and filling in the gaps.
STEP 8
Further information on WASH assessment techniques and tools

can be found in here.
23
The WASH assessment techniques that are most used in the Red
Cross are direct observation and interviews with local authori-
ties and community members, especially during the first phase of
the response. Other tools, frequently used after the onset of the
response, like three pile sorting, mapping, voting chart, survey,
etc. should be used as soon as possible as they foster commu-
nity engagement and prompt community member to agree on
joint action. Some tools could be combined with the same group
of people, e.g. Three-pile sorting with a Focus Group Discussion,
depending on the context – people’s time etc. These participa-
tory, interactive methods may not be easy in the early stages of
an emergency response, but use these methods as much as pos-
sible during the initial assessment, working with the NS and the
community.
Secondary data can be collected from various sources such as NS,

Government ministries, local authorities, health clinics in the dis-
trict or community, other agencies working in the communities. It
is important to gather secondary data from reliable sources.
Sample Assessment Form provides an outline checklist of infor-

mation to collect and the type of collection sources: this should
be adapted to the context
As the data is collected, it should be analysed; comparing infor-

mation from different sources, checking the information being
gathered is relevant and is useful to answer the key questions
about the problem, the affected population, the capacities and
needs. Analysis is a very vital step that will help to understand
the situation and respond more effectively. Do not leave the anal-
ysis until the end of the assessment. Triangulate the information,
analysing data from different sources with different methods, to
check for gaps and inconsistences.
24
INTRODUCTION
A clear assessment report is essential, this will provide the basis

for programme planning and monitoring. Remember: record it,
STEP 1
share it and use it!
Q: W hat are the challenges of when doing a Rapid

assessment.
STEP 2
A: 1. It is often difficult, especially in large-scale emer-
gencies to identify the most at-risk and vulnerable
groups; coordination and collaboration with other
STEP 3
organisations is essential, to ensure there are no
gaps and to avoid duplication. Aim to gather infor-
mation from the most affected areas.
2. As the initial rapid assessment may target the most
vulnerable groups, it is not always possible to gen-
STEP 4
eralise this information for all the affected area
3. The data can quickly become out-dated or irrele-
vant, particularly in disaster that involves on-going
population movement
STEP 5
4. Rapid assessments may take time to complete, es-
pecially in a chaotic environment, so care should
be taken not to spend too long on the assessment
and delay the implementation to respond to the
STEP 6
priority needs
STEP 7
STEP 8
25
Q: Should the team wait until the assessment is com-

pleted before responding?
A: No, if there are immediate urgent needs, the response

should start; e.g. In a response to a cholera outbreak,
the population might need urgent help and infor-
mation on treating drinking water. BUT – a rapid as-
sessment should always be done to make it effective
response. For example; in a cholera outbreak it will not
be effective to give out posters if the population is illit-
erate and without proper assessment this information
might not be known. And doing some few HP activities
in the communities will provide you guidance for fu-
ture activities on what people accept and like.
26
INTRODUCTION
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
STEP 6
STEP 7
STEP 8
27
STEP 2
IDENTIFYING
TARGET GROUPS
28
INTRODUCTION
Step 2 Identifying Target Groups
Step 2: I dentifying
Target Groups
STEP 1
The second step in the process of developing the
Hygiene Promotion plan, is to identify the target
STEP 2
groups. For each of risks or hygiene problems
identified in assessment (Step 1), it is important
to identify who needs to be prioritised.
STEP 3
Important considerations must be given to the following.
� Identify those who are most at risk. To ensure that all WASH
activities reach out to the most vulnerable1, a gender and
diversity analysis should be done for selecting the target
STEP 4
groups and participation criteria.
� If working in refugee/camps for displaced people, it may be
appropriate to consider the surrounding host population,
depending on the context.
� Identify who are the influencers (e.g. community and religious
STEP 5
leaders) in the affected community, do a stakeholder analysis.
� Identify the different sections of the affected community,
considering their different needs: (including children, older
people, people with disabilities, marginalised and hidden
groups) and other stakeholders STEP 6
� Special emphasis on the needs of babies and young children,
as they need different WASH facilities
� Ensure that the aspects that affect specific groups such as
menstrual hygiene management for women and adolescents
STEP 7
is considered.
STEP 8
1
I FRC, 2015, Minimum standard commitments to gender and diversity in emergency
programming, pilot version
29
People’s decision-making depends on the information they have,

their ability to participate and engage in the programme. Their
full participation may not be achieved at the onset of the emer-
gency, especially in those disasters with high level of destruction,
human loss and trauma, but at least some basic level of consulta-
tion and information needs to be established from the beginning
of the operation. As soon as the situation becomes more stable,
the affected community needs to be fully engaged in the planning
process, including the selection of behaviour change objectives.
Work with the engineers when identifying target groups, visit the
communities together, the hardware and the software needs to
link together.
An important aspect to consider is assessing how different groups

in our target population communicate. Knowing their communi-
cation habits before the emergency and how they communicate
now in the new emergency setting is important for the selection
of communication channels later. This should be part of the as-
sessment. Understanding the daily life of the different groups in
the new setting, what opportunities they have for interaction and
communication, and what channels are more effective may in-
form the design of the hygiene promotion intervention.
30
INTRODUCTION
Step 2 Identifying Target Groups
Q: In an outbreak of cholera everybody in a community is
STEP 1
affected, so isn’t it important to target everyone?
A: Yes, in a cholera outbreak, hygiene promotion is im-

portant for all the community; but the approach
will be different for the different groups – the pri-
STEP 2
mary target groups are the members of the house-
hold, i.e. the children, parents, grandparents and
child caregivers. Each of these groups should be tar-
geted differently – the method to reach them (to
STEP 3
provide information and involve) will be different.
The secondary group will be people who have influ-

ence to take-action and to help (e.g. the local commu-
nity leaders who can help to spread the information on
STEP 4
proper hygiene methods).
STEP 5
STEP 6
STEP 7
STEP 8
31
STEP 3
ANALYSING BARRIERS
AND MOTIVATORS
FOR BEHAVIOUR
CHANGE
32
INTRODUCTION
Step 3 Analysing Barriers and Motivators for Behaviour Change
Step 3: A
nalysing Barriers
and Motivators for
STEP 1
Behaviour Change
STEP 2
In Step 1 the key public health risks and the
needs were identified. In step 2, those who are
most at risk, therefore need to be prioritized in
the intervention, have been identified. Step 2 has
STEP 3
also helped to understand how they can be en-
gaged in the action and how they communicate.
Step 3 will help hygiene promoters to understand people’s behav-
STEP 4
iour by listening and discussing with all sectors of the commu-
nity. To understand their behaviours and what motivates these
behaviours; these are inf luenced by the context, their beliefs,
values and social pressure. In an emergency, there will be many
barriers and constraints.
STEP 5
There are many models that describe the complex issue of behav-
iour change; but in general, it is widely recognized that hygiene
promotion intervention in emergency need to move away from
the common assumption that imparting knowledge about germs STEP 6
and disease will change behaviour are needed. It is more complex
to change behaviours than simply giving out information; e.g.
telling someone to wash their hands and expecting them to do it.
STEP 7
A simple way of approaching behaviour change is first to ac-

knowledge that people living in extreme conditions caused by
disaster may have already some level of automated hygiene be-
haviour often as part of an existing pre-disaster routine. It is im-
STEP 8
portant to find these behaviours with the assessment, so proper
33
physical means can be offered to ensure those behaviours can be

sustained by the affected community.
Secondly it is important to examine the barriers and motivators –

they are not always what you think!
During the assessment, the team gathers information about the

different motivators that can trigger change in the affected popu-
lation. Although this step is part of the assessment
� Motivators: anything that would motivate people to practice

correct hygiene behaviours. In the light of emerging develop-
ments in psychology, anthropology and marketing science, it
has been proved that most of human beings regardless their
physical, cultural and social context share some key drives
and emotions that are connected to a state that is good for
their survival. Those drives have been identified as universal
drivers and can be categorised:
Motivator Tendency Example
Disgust Tendency to Faeces, urine, bodily fluids

avoid objects and rotten or dead items
and situations are universally found to be
carrying disease particularly repulsive. For
risk. some, the smell or sight of
faeces alone is enough to
motivate handwashing.
Status Tendency to seek Being seen to be clean

to optimize social could lead to being admired
rank and respected, being
labelled as ‘dirty’ is often
thought shameful and to be
avoided at all costs.
34
INTRODUCTION
Affiliation Tendency to seek Being a good member of

to conform to society by joining in and by
STEP 1
reap the benefits doing what everyone else
of social living is perceived to be doing
is an important motive
to practice key hygiene
STEP 2
behaviours. This helps
ensure membership in the
social groups. Conformity
with local social norms is
known to be a powerful
STEP 3
driver of behaviour.
Attraction Tendency to be In some cultures,

attracted to, and cleanliness is a seductive
want to attract, art. Note that cultures that
STEP 4
high-value mates. value modesty and purity,
this driver cannot be easily
discussed.
Nurture Tendency to Parents, specially mothers,
STEP 5
want to care for almost always placed
offspring. children first. Mothers feel
a keen responsibility and a
duty to ensure the smooth
functioning of the family, STEP 6
to keep the child growing
well. These feeling could
be even more exacerbated
during emergency time
STEP 7
STEP 8
35
Comfort Tendency to place People value having a skin

one’s body in that is free from disgusting
optimal physical, substances and enjoy
chemical the sense of cleanliness
conditions. directly and as a state of
mind: being clean implied
inner comfort, freshness,
readiness for anything,
confidence and purity.
Fear Tendency to For example, reports

avoid objects have suggested that
and situations handwashing did increase
carrying risk of during epidemics of cholera
injury or death (Uganda, Senegal, Kenya
(Specific health and Peru). However, people
fears have been reported that they returned
used in the past to their usual handwashing
during emergency habits once this danger had
response around passed.
life-threatening
diseases such
as cholera and
recently about
Ebola and others ).
� Assessment techniques such as Focus group discussions

(FGDs) and in-depth key informant interviews can offer a
good insight of what drivers and emotions can be factored in
the behaviour change plan, influencing the selection of pro-
motional activities and formulation of hygiene messages.
36
INTRODUCTION
The same assessment techniques mentioned above should also

provide evidence of what stops people taking action by them-
STEP 1
selves:
� Barriers: anything that will hamper people from practicing
correct hygiene behaviours; e.g. physical barriers – access to
facilities such as soap, water, suitable toilets; social barriers –
norms and customs, lack of trust of health works and health
STEP 2
information; biological barriers: mental state. The table below
explains different kinds of barriers in detail.
Socio ÌÌ In some cultures, hygiene practices, such
STEP 3
cultural as handwashing w it h soap might be
barriers avoided due to various local traditions and
beliefs; such as soap is not used because it
is considered to bring bad luck, reduce life
STEP 4
expectancy, weaken the resistance of the
body to external illnesses and witchcraft
or harm a pregnant / menstruating woman.
ÌÌ These beliefs are very diverse and specific
to local cultures, as one would expect.
STEP 5
People in general, however, do not share
such beliefs to the interviewers, unless it is
prompted, for reasons; they will be labelled
as being superstitious, they are accepted
without reasons of doubt and they do not STEP 6
find fault in it.
ÌÌ S o m e h y g i e n e p r a c t i c e s s u c h a s
ha ndwash i ng b elong to t he pr iv ate,
individual sphere therefore not perceived
STEP 7
as a social norm.
ÌÌ Gender relation inf luence how water is
allocated to the different members of the
family and when it is scarce specific group
STEP 8
like women, children, elderly, etc. may not

get an equal share.
37
Physical ÌÌ Physical factors that affected the practice

barriers of key hygiene behaviours in emergency in-
cluded water, soap and toilets.
ÌÌ Access to enough water is a key constraint
in emergency. When services are provided,
queueing and intermittent supply might
continue to be a problem for some people. A
water source specifically for handwashing,
needs to be located near the toilet units.
ÌÌ Soap is often unavailable at the onset of the
emergency. When distributed, soap bars
can still be difficult to access due to family
members keeping it wrapped and held out
of reach, to save them from being ‘wasted’
or being dirtied or from being eaten by do-
mestic animals. It is important to note that
convenience of use is important, the pres-
ence of soap near the latrine and kitchen
area drives people to wash their hands
more than not having it around or going
somewhere else to find soap to wash their
hands.
ÌÌ Access to sufficient number of hygienic
toilet in emergency is a great challenge.
Public toilets or defecation grounds pro-
vided at the beginning of the emergency
operation can be distant, difficult to main-
tain and not the preferred option for vul-
nerable groups such as women, children
and those with less mobility.
38
INTRODUCTION
Biological ÌÌ Often mothers and caretakers are busy

barriers during emergency time securing shelter
STEP 1
and provision of relief items. Those are
more urgent with little time for personal
and domestic hygiene.
ÌÌ At the onset of the emergency, mothers
and care takers can be simply tired, ex-
STEP 2
hausted and emotionally drained to focus
in non- priority matters that are not easily
perceived as life/saving (such as water,
food and shelter).
STEP 3
A planning tool such as the table below (Sample table to analyse
barriers and motivators) which finds the barriers and motivators
for specific target groups and the reasons for the actual behaviour
STEP 4
and understandings can be used to understand different behav-
iours and to analyse it.
Sample tool to analyse barriers and motivators

Target Behaviour Barriers Motivators Approaches Approaches
STEP 5
group to reduce to increase
barriers motivators
Pregnant Do not use Socio cul- Nurturing: Clear mis- Community
women soap for tural barrier: desire to conceptions champions –
washing Belief that protect about using images/films
STEP 6
hands and soap brings children soap with of women
body bad luck help from perceived as
and causes community ‘good moth-
miscarriage leader/health ers’ washing
workers. their hands
with soap.
STEP 7
Physical Affiliation: Distribute Promote the

barrier: Desire to fit soap idea that
No soap in with oth- everyone is
ers and be doing it.
perceived
as a good
mother
STEP 8
39
The analysis of the factors that prevent the uptake of safe prac-
tices should be done with community members and other rel-
evant stakeholders.
Barriers to Behaviour Change
Remember that those factors stopping people to behave safely are not
always related to lack of knowledge about the theory of germs or disease
transmission paths. More often those barriers are related to socio-cultur-
al factors (in some cultures a woman and her father-in-law cannot share
the same toilet), religious (specific siting of facilities) or physical (absence
of facilities or no access to them).
Assumptions should not be made that people do not have the knowl-
edge, they may understand differently! It is the task of the hygiene pro-
moter to discuss with the community, and analyse how people think, in
conjunction with what they know.
Hygiene Promoters should try to reduce the barriers and build on the
motivators
Q: Doing a barrier and motivator analysis in emergency

takes time and this might not be a priority by man-
agers, fellow engineers and team leaders. How can hy-
giene promoters convince others that this is important?
A: The analysis of barriers and motivators for hygiene

promotion should be done ideally as part of the general
assessment and not a separate exercise. By spending
the same resources, hygiene promoters should draw
some basic conclusions from the assessment and
judge which of those factors are having more likely
value than others in promoting safe hygiene behav-
iour. Hygiene promoters should be encouraged by col-
leagues and team leaders to take some time for greater
assessment and planning, encompassing concepts
such as motivators and barriers.
40
INTRODUCTION
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
STEP 6
STEP 7
STEP 8
41
STEP 4
FORMULATING
HYGIENE BEHAVIOUR
OBJECTIVES
42
INTRODUCTION
Step 4 Formulating Hygiene Behaviour Objectives
Step 4: F
ormulating Hygiene
Behaviour Objectives
STEP 1
The next step in the process is setting the objec-
tives. After identifying the major risks and prob-
STEP 2
lems (step 1), prioritising the groups within the
target population, understanding who influence
them and how they communicate (step 2), hy-
giene promoters need to work with the commu-
STEP 3
nity, the engineers and other key stakeholders (e.g. Government)
and consider:
� Are there any existing coping mechanisms?
� What capacity does the community have?
STEP 4
� What assistance is being provided by others?
� What are the gaps?
The objectives for the hygiene promotion plan can be related to

hygiene behaviour (such as increasing handwashing practice at
STEP 5
key times) or an enabling factor (e.g. availability of handwashing
facilities with soap) so engineers need to be part of the process.
For example, Specific Operation & Maintenance (O&M) objectives
should be included in the planning (e.g. engaging the affected
population in maintenance of toilets and water systems). STEP 6
The formulating hygiene behaviour objectives means setting up
specific directions of the hygiene promotion activities to focus on
the most important things to enable people to change behaviour.
STEP 7
Addressing to reduce barriers and to boost motivators for dif-

ferent target groups (from the analysis done on Step 4) by setting
objectives and activities to make a pathway to minimize risky
health behaviours and to reduce diseases.
STEP 8
It will be good to link these objectives identified with the objec-

tives given on the IFRC PoA template and the WASH activities list
43
for emergencies. The objectives and activities chosen by hygiene

promoters may not be the same but it will provide guidance and
structure to the hygiene promotion team delivering activities on
the ground and to their managers and / supervisors. Sometimes
objectives for hygiene promotion in NS Plans, IFRC PoAs or ERU
logical frameworks might be general, short and concise but this
step advocate for hygiene promoters taking proper time to plan
their own objectives and developing comprehensive and detailed
plans.
Q: W hat do you do if you find that knowledge levels are

high, but hygiene practices are still unsafe? For ex-
ample, people know how diarrhoea is transmitted, but
do not practice handwashing at critical times.
A: It is important to find out the root causes. Knowledge

is not the same as action. It may due to a lack of re-
sources – e.g. no soap. Has anything altered since the
disaster? It may be that men and women may have to
share emergency toilets, which may be culturally un-
acceptable. If information received from the rapid as-
sessment is not enough or clear, then gather additional
information using a variety of methods with different
groups of people and adjust the hygiene behaviour ob-
jectives.
44
INTRODUCTION
Step 4 Formulating Hygiene Behaviour Objectives
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
STEP 6
STEP 7
STEP 8
45
STEP
PLANNING
5
46
INTRODUCTION
Step 5 Planning
Step 5: Planning
STEP 1
The next step is finishing the hygiene promotion
plan by putting together all elements identified in
previous steps: major risks (Step 1), priority target
STEP 2
groups (Step 2), motivations / barriers (Step 3) and
objectives (Step 4). The Step 5 on planning is
about documenting properly the previous steps
and creating a work plan that includes all those elements above
STEP 3
and linking to specific activities with methods and tools, re-
sources needed (both financial and human) and a monitoring and
evaluation plan.
STEP 4
The hygiene promotion plan should not be made in isolation by
the hygiene promotion team. This plan is more effective when
hygiene promoters work with others; the engineers (who are de-
signing and implementing hardware such as toilets, water and
washing facilities), the affected community, local government,
STEP 5
other agencies, NS staff, etc. The hygiene behaviour objectives are
set from the identified problems for the different target groups
with the motivators and barriers. These objectives will be the
basis of the planning. The approach and methods must be se-
lected to meet these objectives. STEP 6
The hygiene promotion team might be very focused in developing
their own hygiene promotion plan, but they need to also con-
tribute into other planning processes like:
STEP 7
a. Completing the Logframe or Plan of Action of the wider WASH

operation, incorporating their own monitoring plan and hy-
giene promotion plan
b. Preparing and conducting baseline survey
STEP 8
c. Recruitment of the Hygiene Promotion Team

d. Designing the methods, tools and materials
e. Pilot and pre-test the materials and methods
47
a. Completing the Logframe, with a monitoring plan

The WASH team together should compile an ‘integrated’ (i.e.
hardware and software) logframe (Logical Framework) or Plan of
Action (PoA) for the Emergency WASH programme as a tool to
guide the programme; including the hygiene promotional activi-
ties, the hardware construction activities – i.e. the WASH facili-
ties, and any Non-Food Items (NFIs) needed.
A monitoring plan must be made as part of the planning process.

The indicators form the basis of the monitoring and should give a
clear idea of what changes are needed and by who. The full list of
indicators is given here.
The indicators should be: specific, measurable, achievable, rel-

evant and time-bound (SMART). Indicators are linked to the out-
comes and outputs – not inputs. The selection of indicators and
the ways to measure will change according to the context but
each indicator should have a target group. The indicators should
be based on the Sphere standards and any national standards, as
possible. The monitoring should be done to measure the changes
as they happen or fail to happen, so changes to the activities can
be taken on time. The monitoring plan can include many different
simple tools to monitor so information can be collected by dif-
ferent means.
48
INTRODUCTION
Step 5 Planning
Example of part of a logframe (from BRC MSM Handbook):

Outcome Indicators Means of
STEP 1
Verification
Men, women and � Areas within X Exploratory walk

children in the m radius of all reports
target population (x dwelling and water
Focus Group
no.) have sufficient points free from
STEP 2
Discussions
access to, and observable excreta
make optimal use by end of Phase 1 Information from
of, sanitation and other organisations
� X% of target
hygiene facilities, and
population using Surveys
take effective action
STEP 3
sanitary latrines by
to protect themselves Community
end of Phase 1
against threats to monitoring tools
public health. � X% of latrines
are clean on spot
inspections
STEP 4
� X% of the target
population washing
hands with soap /
alternatives by the
end of Phase 1
STEP 5
b. The Baseline Survey
Once the target group and programme plan are agreed a base-
line survey needs to be done to establish the current situation STEP 6
and to enable programme impacts to be measured. This will be
the starting point of monitoring the hygiene promotion activities.
The baseline survey will be developed based on the indicators
identified during the planning stage. Baseline and end-line survey
STEP 7
questionnaires will form the base of the evaluation of the impact

of the intervention. The baseline should collect information dis-
aggregated by sex, age and disability – plus ethnicity/caste where
relevant.
STEP 8
49
ÌÌ Questionnaire design for household interviews: The baseline

questionnaire is developed based on the indicators. Only in-
clude those changes that you are hoping to achieve – each
question should be linked directly to an indicator. Use obser-
vations (e.g. of water storage, hand washing points or latrines)
wherever you can and avoid closed questions (with a yes/no
answer). The questionnaire should be short and simple, based
on approximately 10-15 questions. Make sure the question-
naire is translated, back translated and checked for accuracy.
If possible and applicable to the context, digital mobile survey
questionnaires can also be used.
ÌÌ Sampling: A simple random sample is the best approach to
use, so every subject in the sampling frame has the same
probability of being selected. For all sizes of population, a
random sample of around 150 households should be suffi-
cient. If a random sample is not used then it the sample size
will need to be increased. The simplest approach to sampling
is to use a spatially distributed sample with a random start1.
For more information and guidance on sampling, refer to the
IFRC ERU-MSM sampling document.
ÌÌ Survey implementation: Working with the NS to get access
to the community, including informing the community and
gaining consent, with permission from authorities/armed
groups. Ensure the logistics is organised, and security is
considered. Make sure you are not putting the volunteers or
target population at risk by involving them in the survey.
Questionnaires should be anonymous. Ensure the team is
trained in both quantitative and qualitative data gathering
and they are involved and understand the process. For house-
hold interviews, think about whom you want to question
in each household – household head, caregiver or women
1
Sample every Nth household. N = Sampling interval = (No. houses/or tents in total
population / No. houses/or tents which need to be sampled). Random start is a
random number between 1 and N.
50
INTRODUCTION
Step 5 Planning
15 – 49 years? Pilot the survey to ensure the questions are

clear, appropriate and the sampling method works. Record
STEP 1
the methods used, so the end-line survey repeats the same
methods. The end-line should be a repetition of the base-
line as far as reasonably possible; using the same questions
and sampling approach – even repeating the same errors!
Document the results and feedback to the team, the users
STEP 2
(e.g. WASH team, NS other organisations) and the affected
population.
c. Recruitment of the Hygiene Promotion Team
STEP 3
Identifying appropriate Hygiene Promotion staff and volunteers
is important for an effective hygiene promotion programme. The
existing system of NS volunteers may be adequate, but it is likely
to respond to an emergency, the team will need to be expanded,
STEP 4
depending on the context.
The structure of the Hygiene Promotion team will depend on

the context, such as the size of the emergency, the capacity, the
needs, the risks, the presence of ERU teams. One model is:
STEP 5
ÌÌ Hygiene Promotion Coordinator (this may be an ERU delegate,
or someone from the NS)
ÌÌ Hygiene Promoters – who manages a team
ÌÌ Community mobilisers / Outreach Workers from the affected
community- who works with community level volunteers STEP 6
ÌÌ Community level volunteers – to work with community com-
mittees such as WASH committees
The numbers of staff and volunteers at each level would depend

STEP 7
on the context; e.g. if there are high numbers of population with

many risks, more volunteers would be needed at community level.
But for planning and supervision it is normally recommended to
have teams of 7-10 people.
STEP 8
51
Some NS have Volunteer Management Policies. Those policies

may have a special section for emergency response, but in gen-
eral they provide guidance about per diem, days per week they
are expected to work, type of volunteers, recruitment, retention
and motivation.
The issue of remuneration and incentives for staff and volunteers

should be agreed before the recruitment and selection of the team
and in coordination with IFRC and other RCRC teams operating in
the same area. This should be led by the NS, with other key stake-
holders, and in coordination with other organisations working
in the areas. The volunteer management policy can be useful for
setting up a per diem framework for the hygiene promotion inter-
ventions.
There should be clear job descriptions established before the re-

cruitment for all the staff and volunteers, organised by/with the
NS, which should be agreed with all the stakeholders. The job de-
scriptions should include lists of key skills and competencies, and
may need translation if working in a context where different lan-
guages are spoken, e.g. refugees from another country.
In an emergency response, it can be challenging to get the ideal

qualified staff and volunteers from the NS local branches. When
selecting staff and volunteers for Hygiene Promotion team.
General IFRC guidelines on Volunteer and Youth engagement can
be found here.
Ensure that NS volunteers have insurance. In case you need

further information please contact insurance.unit@ifrc.org
52
INTRODUCTION
Step 5 Planning
d. Designing the Hygiene Promotion methods, tools and

materials
STEP 1
Selecting the Approach and Methods
It is important to select the most suitable approach and methods for

Hygiene Promotion; ensuring they are the most appropriate for the target
groups, context and the hardware facilities. The analysis of barriers and
motivators in step 3 need to inform selection of promotional approaches
STEP 2
/ methods and the development of messages and supporting IEC ma-
terials.
It is essential that the approach focuses on ‘enabling the community’,
helping them to agree on community actions and facilitating the imple-
STEP 3
mentation of the actions; rather than simply ‘we are doing hygiene pro-
motion’ which often translates into teams of hygiene promoters telling
communities what to do, or educating others with standard messages,
acting as if they know better; this approach is rarely effective.
Separate consultations with women and other vulnerable groups (people
STEP 4
with disabilities and transgenders, etc.) might be needed as they might
not be willing to share it in a large group.
STEP 5
Key points for planning methods to promote hygiene
Ensure the methods for hygiene promotion respond
to the hygiene behaviour objectives (in Step 4), the
overall aim, and the context, based on the risks iden-
tified in the assessment STEP 6
Ensure the methods consider the barriers and the mo-
tivators appropriate to the context (Step 3), based on
the findings of the assessment (Step 1), aim at encour-
aging healthy behaviours
STEP 7
STEP 8
53
Use a combination of methods with different type of

communication tools that can be used for different
purposes (increasing awareness, sharing knowledge,
influencing & inspiring others, make decisions, etc.).
Focus on the target groups identified in Step 2.
– When designing the methods, tools and materials,
focus on the target group, involve the community in
choosing the most appropriate methods and tools
for their situation
– Consider the public health risks, and chose the
methods appropriate for the different target groups.
For example, children under five years of age, who
are more at risk for diarrheal disease, involve their
mothers and caregivers to focus on proper hand
washing at key times (e.g. after using a toilet, before
feeding a child) but also involve children in inter-
active activities, (such as games, puppets, clowns,
dramas), to promote action such as hand washing.
Games such as Snakes and Ladders board game are
popular with children (going ‘down the snake’ for
problems – e.g. open defecation or ‘up the ladder’ for
good behaviour, e.g. knows the key times to wash
hands). People follow what they like or they are part
of rather than what they hear.
54
INTRODUCTION
Step 5 Planning
Focus on participatory methods
STEP 1
– Not all methods for hygiene promotion require the
use of ‘hygiene messages’. Participatory techniques,
for example three-pile sorting, are focused on cre-
ating debate rather than simply passing on a mes-
sage. The aim is to identify problems and agree on
STEP 2
potential solutions that require community action,
by working with the community.
Choose an appropriate channel for communication
– Through a trusted channel; are there particular
STEP 3
people (gatekeepers/influencers) or channels which
people do and do not trust (this information is gath-
ered in Step 2 when understanding people’s com-
munication habits)– this may be specific to the
STEP 4
information/activity
– Reaching the audience in the planned setting; for
example, most households may have radios, but
they may be only used by certain family members.
– Tailored to the target group, e.g. for children in
STEP 5
schools – use something that is suitable to them
such as puppets or dramas.
– Culturally appropriate in this context. In some con-
texts, dancing and singing are acceptable; in others,
it is not appropriate. STEP 6
– Enjoyable / Participatory: people should enjoy the
activity and feel involved, are able to discuss the in-
formation, so that it is two-way communication –
not simply passing on messages.
STEP 7
STEP 8
55
Choose an appropriate location

– Schools, youth groups for young children
– Community central areas for group meetings
– Quiet areas for Focus group discussions
Work with the engineers to ensure that the hygiene
promotion methods link with the hardware
– With the engineers, work with community groups
such as WASH committees to strengthen and pro-
mote the community engagement (e.g. maintenance
of facilities), ownership and sustainability.
There are a wide range of hygiene promotion methodologies

which are split here into six groups. Using a combination of these
methods in this list will help reach all sectors of a community:
Mass communication through Think about who has access to the
the media (TV, radio, SMS, social media used and what groups will
media, leaflets, etc.) be reached. If mobile phone use
is common with all the population,
it will be easy to pass rapid mes-
sages with mobile text, e.g. about
cholera. Mass communication
may be helpful in the early stages
of the response, but there needs
to be more emphasis on working
with the community as a two-way
process. Include some interaction,
e.g. ‘phone-ins’ with questions on
radio programmes. Some good
examples of using mass media in
emergency hygiene promotion are
given here.
56
INTRODUCTION
Step 5 Planning
Community activities (e.g. Teams from the community are

drama/mime, songs, storytelling, trained to put on shows in a small
STEP 1
films etc., focusing on key hygiene number of communities. Also,
practices such as hand washing. short shows with music and songs
Activities specifically for chil- to be sung together. More ideas
dren, e.g. puppet shows, clowns, can be found here.
games etc.
STEP 2
Group activities (e.g., visual aids, Trained hygiene promoters and
such as posters and flip charts, community mobilisers work with
F-diagram/diarrhoea transmis- groups of varying types and sizes,
sion, community mapping, three- depending on the activity and the
pile sorting, pocket chart voting, context. Most of these are taken
STEP 3
board games; all linked with dis- from the PHAST and CLTS tool-
cussions kits (see below for information on
PHAST and CLTS), but need to be
adapted to the emergency con-
text; i.e. the process should be
STEP 4
quicker.
Identify and work through Families/individuals which are

community ‘champions’ influential in the community and
whose positive hygiene behav-
iours can be taken as examples by
STEP 5
other community members. These
community ‘champions’ can be
used to promote positive behav-
iours and be involved in promotion
activities.
Personal communication: Working with volunteers (e.g. NS

STEP 6
home visits, group discussions volunteers), community mobilis-
ers, community leaders, religious
leaders etc.
STEP 7
STEP 8
57
Nudging Nudges are environmental cues

engaging unconscious decision-
making processes to prompt
behaviour change. Examples of
nudges: (1) connecting latrines to
the handwashing station via paved
pathways that were painted bright
colors; and (2) painting footprints
on footpaths guiding users to the
handwashing stations and hand-
prints on stations (3) mirrors at the
hand washing stands
Existing/current methodologies used by the NS

It may be easier to adapt the Hygiene Promotion methodolo-
gies, which are known and used by the NS and the local Health
Authorities. The advantage of adapting these methods are that
the volunteers/NS will have the knowledge of the methodologies
(minimising the need for training for the volunteers) and they are
able to use the existing hygiene promotion materials (adapted to
the culture of the community) and the activities can be started
quickly (less time needed to pre-test). However, normally these
methods use a long process, which is not suitable in an emergency
when the response needs to be fast; so, the tools need adapting.
ÌÌ CLTS: Community Led Total Sanitation (CLTS) is an approach

widely used by many NSs to eliminate open defecation by
triggering shock of the ‘disgust’ in rural communities. It is
the government policy of many countries in Asia and Africa
and the NSs use it. The initial aim of CLTS of shocking people
into action may not be relevant or useful in the aftermath of a
disaster. Similarly, negative images and ideas should be used
with caution especially if practices were good prior to the dis-
aster and the main barriers are linked to lack of services.
58
INTRODUCTION
Step 5 Planning
ÌÌ P H A S T : The P a r t ic ip at or y Hy g iene a nd S a n it at ion

Transformation (PHAST) approach aims to improve hygiene
STEP 1
behaviours to reduce diarrheal disease and encouraging ef-
fective community management of water and sanitation
services. The principle of the approach is the participation
of communities in their own projects, empowering and en-
gaging them in the decision-making about the services they
STEP 2
need and want to improve or maintain. PHAST tools can be
adapted for use in the assessment and as participatory group
activities during implementation. Community Action Plans
could be a useful tool to get a community to work together to
STEP 3
take action to improve their situation.
Sharing information with the affected community:

DON’T DISSEMINATE – COMMUNICATE!
STEP 4
Mass dissemination of information with messages will largely
be ineffective. Two-way communication will be more effective,
working with the community, giving them the opportunity to be
involved and to discuss. Combine with participatory activities
(like mapping), including practical information to enable the af-
STEP 5
fected community to take some action to address the health risks.
Hygiene messages sometimes are understood as printed mate-

rials that contain graphic messages (in writing or picture). The
hygiene message is more than a printed material. All hygiene STEP 6
promotional activities are constructed around a central message,
even participatory tools like mapping are always undertaken
around a theme or message (use latrines, do not defecate in the
open). Hygiene messages are in general derived from the need to
STEP 7
communicate in brief to a target group.
As printed and visual materials are always part of the hygiene

promotion activities in an emergency it is important to under-
STEP 8
stand how messages can be created professionally. In some sit-

uations, messages will be provided by the Ministry of Health
59
and hygiene promoters will have little room for changing those
printed messages. However, in those situation, when messages
can be shifted and adapted to the context, it is recommended for
hygiene promoters to develop a message brief: this helps to de-
velop the concepts, craft the messages, and create materials for
the intervention.
Message briefs should be:

Simple: use simple wording and use words commonly used in the local
language/dialect so people can understand. Remember what you say
can make a different on how you say it. Do not overload people with too
much information at one time. Messages must depend on the context
and the circumstances.
Tailored: to both the cultural context and the actual hygiene problems;
you need to use messages that beneficiaries will not find offensive or
insulting; hygiene issues may be very specific. Information needs to be
tailored for each stage of the response and developed in parallel to de-
velopment of hardware.
Feasible: the messages and the changes you want to trigger need to be
feasible. For instance, it would be pointless to encourage beneficiaries
to practice hand washing with soap if you find out that there is no soap
available.
Accurate and Consistent: Provide people with consistent information.

Collaborate and coordinate with other organisations, Health Authorities
etc. to ensure there are no potential discrepancies.
Contain a mix of information and emotional motivators: Linking

to an emotional motivator can lead to a higher impact than information
based messages which people may already be aware of. CLTS has
some strong emotional motivators around disgust which can be adapt-
ed. Messages should emphasize to point out the benefits of conveni-
ence, comfort and privacy.
Participatory: Community members must be involved in structuring

the messages to ensure that the messages are intent on the community
for enabling acceptance and understanding. This will also help the com-
munity to follow and advocate the messages.
60
INTRODUCTION
Step 5 Planning
e. Pilot and pre-test the materials and methods

Once the methodologies to be used are agreed; prepare the staff/
STEP 1
volunteers and the materials, for example: recordings for radio
shows, printed images, props for dramas, equipment for games,
photos for pocket chart voting etc.
It is important to pilot and pre-test each activity with small
STEP 2
groups from each target group identified in step 2 to check they
are clear and understood; this could be done with a small group
before using it more widely. Involve a representative group from
the target audience in the pre-testing (e.g. radio show, songs,
STEP 3
group activity) followed by a group discussion (and/or several
semi structured interviews) to help identify the following points:
ÌÌ comprehension (visual and aural): Any misunderstandings or
unintended impacts should be identified. E.g. aspects of scales
STEP 4
in drawings – a picture of a large fly may be irrelevant to some
people if they do not understand scale.
ÌÌ recall of the key points: Is the activity memorable? People
must be able to remember and rephrase the information or
what they understood from the activity
STEP 5
ÌÌ action triggers: Are activities likely to trigger any kind of ac-
tion? Ask the group what they would do or change following
the pre-testing
ÌÌ presence of sensitive or controversial elements: Discuss with
the community members to ensure the wording or pictures STEP 6
are not offensive or misleading to them.
STEP 7
STEP 8
61
The information gathered during the pre-testing should be used

to amend the activities. Ensure there is flexibility in the budget
for additional preparation of material as the pre-tests may
identify changes needed and the situation and needs may change
rapidly.
Q: T here are so many methods, which methods work

best?
A: The selection of the method needs to match the target
group and the need; there is no ‘best method’, as some
will work best with some groups and some contexts
than others. Some methods work very well with chil-
dren, and others are better for adults. An ideal is to
have a selection of methods, with some interaction
with the community. Pre-test the methods to see how
they work.
Q: H ow do I practically pre-test?
A: You should select a small group of intended recipi-
ents of your methodology and implement, as it would
be a real session. Prepare in advance some guiding
questions to be asked to the beneficiaries regarding
comprehension and controversial elements. Ask the
questions as if in a focus groups discussion and note
answers. Don’t forget to probe and to include different
groups in the pre-testing since they might have some
different perceptions.
62
INTRODUCTION
Step 5 Planning
Q: Do I need to wait until completing Step 1-5 to develop
STEP 1
my message brief?
A: It is recommended to cover some of the key essential
elements in steps 1-5 to develop a good message brief
and create an effective set of IEC materials for the in-
terventions. Even when pre-ready materials from the
STEP 2
MoH are available, the HP team should ensure that
they meet the message brief table ( page 60) : Simple,
tailored, feasible, accurate and consistent, contain a
mix of information and emotional motivators, partici-
STEP 3
patory.
STEP 4
STEP 5
STEP 6
STEP 7
STEP 8
63
STEP 6
IMPLEMENTATION
64
INTRODUCTION
Step 6 Implementation
Step 6: Implementation
STEP 1
Completing Step 1 – 5 is the way to ensure there
is an effective planning of hygiene promotion ac-
tivities. But as it is an emergency response, the
STEP 2
implementation needs to start quickly, as soon as
all the key stakeholders agree the plans. In most
of the contexts where RCRC operates there is an
enormous pressure to initiate the implementation phase, as some
STEP 3
urgent actions are needed at the onset of the emergency. Hygiene
promoters may cover quickly some of the key elements in the
Step 1-5 and move right away into implementation. Plans however
need to be re-visited and implementation re-adjusted. Pre-tests of
STEP 4
materials and methods may lead to some adjustments and adap-
tations, to ensure that they are realistic and appropriate.
Training of the Hygiene Promotion team

Although it is an emergency, and there will be pressure to re-
STEP 5
spond quickly; all staff and volunteers should have some basic
training on how to work/volunteer for the Red Cross; this includes
knowledge, understanding and how to put into practice the Red
Cross Fundamental Principles, Code of Conduct and humani-
tarian standards. STEP 6
It is not realistic to start with a long training programme; start
with 1 day covering the essential points and build on the skills
with additional training sessions (for example plan for 2 hours of
STEP 7
training/review per week). Daily or weekly debriefing of volun-

teers in the field may also be part of training / mentoring. This
type of ´learning-on-the-job’ approach is often very effective and
appreciated by volunteers. The training is contextualised and
STEP 8
practical, building on the existing knowledge, skills and experi-

ences and focusing on real needs.
65
All the staff and volunteers should know the objective of hygiene
promotion. In summary:
ÌÌ Hygiene promoters: should know how to plan and implement
a hygiene promotion programme, with a monitoring system,
selecting appropriate methodologies for effective hygiene
promotion with community engagement, including an ac-
countability and feedback mechanism.
ÌÌ Hygiene Promotion community level volunteers, ‘Community
mobilisers / Outreach Workers’: should know how to imple-
ment the selected methodologies, ensuring the community
are able to make the best use of the water and sanitation fa-
cilities, that action is taken to prevent diarrhoea and other
water and sanitation related diseases.
Depending on the context, the Hygiene Promoter coordinator

would start by training/refresher training the Hygiene Promoters
and the training would cascade down to the Communit y
Mobilisers and the community groups, such as WASH commit-
tees.
The Trainer’s Manual (in this IFRC Guidelines to Hyg iene

Promotion in Emergencies pack) is divided into two parts.
ÌÌ Part 1- overview on how to implement HP in emergencies ac-
cording to these new guidelines.
ÌÌ Part 2- how to train new volunteers and staff on Hygiene
Promotion in emergencies.
The WASH Cluster has a set of training materials (with a Visual

Aids library) that can be used for training a Hygiene Promotion
team adapting to the context as needed. These training materials
are available on the WASH Cluster website.
66
INTRODUCTION
Managing the hygiene promotion team

As with all the team, it is important that all the staff and vol-
STEP 1
unteers are well managed – that they are clear of their role and
can follow their job description and they are not overloaded with
work, it is likely the staff and the volunteers will be affected by
the emergency themselves. National Societies have their volun-
teer management policies where the key rules for engaging vol-
STEP 2
unteers are stated. Note that the policy may have a specific set of
rules of emergency time.
The Hygiene Promotion team should be easily identified, with
STEP 3
T-shirts, caps, or aprons, and should all have name badges to as-
sist with accountability.
There should be an accountability system, set up after discussing
STEP 4
with the affected community and the National Society, so it is
suitable to the context. A notice board with description of what
the RC WASH team is doing, the staff, the programme, the ac-
tivities etc., and where the community can go to get further in-
formation and how they can give feedback – such as a message
STEP 5
box, if that is suitable (people can write, have paper and pens
etc.) a phone line or named focal points. The Hygiene Promotion
Coordinator should set up a system of managing the feedback, so
it is acted upon and information is fed back to the affected com-
munity. STEP 6
Hygiene Promotion with the Community
The selection of methods is discussed above in Step 5: Planning
and they should be outlined in the Hygiene Promotion Plan.
STEP 7
Remember to ensure the methods are appropriate to the needs

(Step 1), target groups identified in step 2 and the cultural context.
They should respond to the objectives fixed in step 4 and reflect
the analysis of barriers and motivators from step 3.
STEP 8
67
Use a combination of methods, with as much focus on interaction

as possible, with community engagement, not forgetting the em-
phasis is to enable to affected community are able to take action
to prevent water, sanitation and hygiene related diseases.
Collaborate with the engineers, so they are part of the hygiene

promotion activities in the community.
Using the Hygiene Promotion Box

The Hygiene Promotion box is a box (or set of boxes) with a selec-
tion of items that are useful for hygiene promoters to rapidly start
hygiene promotion activities immediately after a disaster. The
IFRC box contains useful items that may not be instantly easily
available including stationary, coloured paper, scissors, paints,
a basic laminator, camera, megaphone, sets of pictures for 4
Sets adapted for different regions : Africa, Middle East , Asia and
Americas, and a sewing kit for making puppets, a full list is here.
Many NS and the MSM ERUs have made their own context specific
HP boxes.
Choose an appropriate setting and timing

The setting will depend upon the target population and method-
ology. When choosing a setting consider; the most appropriate
way, time and place to reach the different groups/community
members, where they are able to participate in the activity and
discuss. Work with teachers to include some activities for chil-
dren in schools, and youth clubs. Depending on the context, it
may be appropriate to have community discussions/activities
where groups gather such as water points. Include some hygiene
promotion in conjunction with distribution of hygiene items.
Think about the other demands on the time of the target popula-
tion and when people are likely to be most receptive.
68
INTRODUCTION
Contracts and Scheduling for mass media

Mass media can be used to maximise the reach of the program in
STEP 1
the first few days after the disaster. The frequency of mass media
will depend on the necessity (for example if access to commu-
nities are not easy) and the budget. The contracts with TV and
Radio stations can done with the assistance from the NS. It is im-
portant to co-ordinate with other WASH implementers to ensure
STEP 2
consistency of message etc. But it will be better to have the TV
or radio programmes done separately from other organizations
to avoid other messages being attributed to the RCRC Movement.
STEP 3
Working together with engineers and others
The hygiene promoters are part of a wider WASH team, and this
team should work together and not in parallel. The team should
have regular team meetings, and do joint reports.
STEP 4
Support to the siting, design, operation and maintenance of
WASH facilities – the hardware
Hyg iene promoters should work hand in hand with RCRC
Engineers and local Government staff involved in the construc-
STEP 5
tion of WASH facilities to ensure that the response is appropriate
to the needs of the affected population and they are able to make
the best use of facilities provided. The construction and promo-
tional activities need to be connected; e.g. there is no point con-
structing a latrine that is technically sound but in the views of STEP 6
the population inappropriate for their use – perhaps in an un-
safe location or not the type of toilet they are accustomed to.
Hygiene promoters are responsible for translating people’s pref-
erences, desires and aspirations related to the design and siting
STEP 7
of WASH facilities to the engineers. The hygiene promotion team

should facilitate discussions with all sections of the community:
men, women, children and disabled to ensure that their views
are heard concerning the design and siting of all WASH facilities;
STEP 8
for example, are laundry facilities for washing clothes are at the
69
correct height, are children able to reach the tap stands, is there
provision for sanitation for children?
All sections of the community should be involved in testing the

facilities to see they are appropriate, and working with the engi-
neers if changes are needed.
Plans should be made for operation and maintenance. Depending

on the context, the Hygiene Team can help establish WASH com-
mittees who could be responsible for the maintenance of facili-
ties, such as water pumps, tap stands etc.
The Hygiene Promotion team works with the Engineers to ensure

there is:
ÌÌ Acceptability – are the facilities in line with local prefer-
ences and norms; e.g. the type of toilets, provision for anal
cleansing.
ÌÌ Accessibility – for all sections of the community; certain dis-
abilities may need access to adapted toilet, provision needs to
be made for sanitation for infants and young children
ÌÌ Security – the risks of sexual and gender based violence can
increase significantly after a disaster; discuss with the com-
munity, ask are there any concerns, check there is sufficient
lighting near the toilets, are there locks on toilet doors
ÌÌ Inclusion – existing divisions and power structures may be-
come more pronounced post disaster; are there ethnic groups
that are being marginalised?
Access to safe drinking water

Hygiene promoters might also work in collaboration with the
engineers for ensuring the population has access to safe water.
Depending on the context, if needed – the hygiene team will pro-
mote household water treatment at community and household
level, supporting the RCRC Engineers in conducting training with
70
INTRODUCTION
the community of water treatment products; and doing follow up

to ensure the community are using any water treatment products
STEP 1
correctly and the water is safe for drinking, ensuring it is safely
stored at household level, in clean containers.
Access to appropriate hygiene items: Relief distribution

Relief distribution in the RCRC is usually done by the Emergency
STEP 2
Relief Teams. Hygiene promoters do not conduct massive dis-
tribution of hygiene related items (hygiene kits, soap, buckets,
etc.), but they might get involved in small-scale distribution as
part of training, demonstration or promotional activities. If
STEP 3
major gaps are identified in terms of access to essential items
(soap, buckets, menstrual hygiene materials), this needs to be re-
ported to the Relief Teams operating within the NS and / or IFRC
Operation. Hygiene Promoters however have an important role to
STEP 4
play ensuring that all members of the community (men, women
& children) get hygiene items that are appropriate to their needs;
they should be helping with the critical link between listening to
the community and communicating with the relief teams. They
should also be assisting with information exchange between the
STEP 5
Relief Team and the community, e.g. providing feedback from the
community after hygiene kit distributions. The hygiene promoters
should be involved with information. For Example: Menstrual
Hygiene or Hygiene kit items satisfaction survey about the hy-
giene items, ensuring all the community are aware about their STEP 6
entitlements; and information and messages about the hygiene
items are appropriate. A kiosk system of hygiene items (where
people can choose and collect items they need) may be more ap-
propriate than distribution of hygiene kits.
STEP 7
STEP 8
71
Coordination and communication with all key stakeholders

Other considerations that should be considered when imple-
menting hygiene promotion plans include ensuring there is good
coordination with all the key stakeholders
ÌÌ The hygiene promotion sub-groups within the WASH cluster
may provide the links to other partners working in the sector
and may also set up technical recommendations that will
need to be considered.
ÌÌ Other agencies responding with hygiene promotion activities
may also share resources and ideas. Coordinating with them
is essential to avoid duplication: coordinate, share and learn!
ÌÌ The affected community may have resources available to
support the activities. The NS may have resources available
– e.g. do they have a HP box, IEC materials or toolkits? The
Government might also have their own standards (e.g.
National Polices may state a specific approach to use).
Q: W hy is it important to distribute soap during emer-

gency response?
A: Soap is important because soap helps to remove the
clinging pathogens and bacteria sticking in the skin,
which cannot be removed water alone. More informa-
tion on soap and hand hygiene can be found here.
72
INTRODUCTION
Q:
I s it impor tant to include Menst r ual Hyg iene
Management and what is the role of hygiene promoter
STEP 1
in this?
A: Y es. It is very important to include menstrual hygiene
management (MHM) in the hygiene promotional activ-
ities and messages. The role of the hygiene promoter
STEP 2
is to discuss with the women in the community, to
find out what common practices exist, their prefer-
ences and current resources for menstrual hygiene
and use that information to influence the design of
STEP 3
the family kits (also called dignity kits, menstruation
kits, women kits, etc.) by giving feedback to the Relief
teams. More information on MHM can be found here.
STEP 4
Q: What if CASH is transferred instead of hygiene items
distribution, should hygiene promoter be involved?
A: C ash transfer prog ramming is getting more ac-
cepted, and in emergencies Cash (vouchers, coupons
or cheques) is distributed instead of hygiene items.
STEP 5
The hygiene promoters’ work will still be important;
it is essential to consult with the communities to un-
derstand their needs and preferences and if a cash/
voucher system would work for them, ensure the
people understand the process and monitor how they STEP 6
make decisions (e.g. buying hygiene items for the
family) to reduce their exposure to public health risks
in disasters and follow the correct use of items.
STEP 7
STEP 8
73
STEP 7
MONITORING
AND EVALUATION
74
INTRODUCTION
Step 7 Monitoring and Evaluation
Step 7: M
onitoring and
Evaluation
STEP 1
Monitoring is important to demonstrate progress
– whether the objectives are being achieved and
STEP 2
feedback is heard and acted upon. All the team
(including the engineers) should be involved and
must understand the monitoring process; this
should be part of the training programme for the
STEP 3
community-based volunteers.
Involve the affected population in the monitoring; not only in the

collecting of the information, but also, they should be involved in
STEP 4
the analysis to help ensure the programme is appropriate to their
needs – they will know best what has happened and why and
by including all sectors of the population, it will help empower
them to have to more control and ownership of the programme.
Different people in the community will have different needs and
STEP 5
maybe different access to facilities, so it is important to involve
all groups of people in the monitoring, e.g. men, women, children,
vulnerable groups etc.
The indicators in the logframe should be used, ensuring they link STEP 6
with the WASH Indicators. The team needs to monitor the pro-
gress and impact of the hygiene promotion programme. This is
to identify trends, e.g. latrine usage; and the need for re-adapting
activities and approaches. A critical question to ask is whether all
STEP 7
sections of the community (men, women, children, disabled etc.,)

are satisfied with the WASH facilities, and are using them.
STEP 8
75
Methods for monitoring include:

ÌÌ Transect walks, observations, talking with the affected com-
munity
ÌÌ Focus group discussions
ÌÌ Observations with basic tally sheets
ÌÌ Pocket chart voting
ÌÌ Mapping
ÌÌ Community meetings
ÌÌ Team meetings
Regular reports and updates of the monitoring information

should be compiled and shared; the information should be dis-
cussed and analysed, for example – considering not only whether
the objectives are being achieved, but also, whether they are the
correct objectives related to the needs. The timing and frequency
of the monitoring will depend on the context; e.g. the scale of the
emergency.
Monitoring should not only focus on quantitative indicators (such

as numbers of latrines), but should also include qualitative in-
dicators (with feedback from the affected population, whether
all sectors of the community are using the latrines and are sat-
isfied with them). Listen to people, including the NS volunteers,
track and follow up on rumours. Monitoring forms, which can be
adapted, are provided in table below. One team member should be
responsible for collating, recording and sharing all the monitoring
data.
76
INTRODUCTION
Indicator Means of Frequency

verification
STEP 1
Environment free from all faecal Transect walks Daily or every
matter two days
Users take responsibility for the Observing Daily or every

management and maintenance communal two days
STEP 2
of sanitation facilities toilets
% of the population wash their Observing hand Daily or every

hands with soap or ash at least washing points two days
after contact with faecal matter
STEP 3
% of the population wash their Daily or every
hands with soap or ash at least two days
before handling food
Clean water used for drinking Spot checks at Daily or every
STEP 4
water points two days
Water is stored safely in the Spot-check of Weekly

home (clean, covered households
container)
STEP 5
Women are enabled to deal FGD Monthly
with menstrual hygiene issues in
privacy and with dignity –
Water points and sanitation Observing water Daily or every

facilities are accessed by all points and two days
sections of the community facilities STEP 6
FGD Monthly
Hygiene Promoters trained and Staff feedback One week and

effective on quality and one month after
STEP 7
use of training training
Community feedback routes are Record forms, Weekly

in place and feedback is acted team meetings
on
STEP 8
77
Indicator Means of Frequency

verification
All sections of the community, FGD Monthly

including vulnerable groups, are
consulted and represented at all
stages of the project
It is also useful as part of monitoring, to keep a decision log, docu-

menting how and why decisions about the programme are made;
this is important in an emergency context, as there may be rapid
turnover of staff, and reasons for decisions may quickly get for-
gotten.
Evaluation
The main aim of an evaluation is to make a judgement on the
value of the activities and their results. Has the programme made
a difference, has it helped saved lives, and alleviated suffering?
There are two main purposes of evaluations – those which focus

on learning (documenting lessons learnt) and those which focus
on accountability (reporting to others what has been achieved.
There are numerous types of evaluations that can be used, de-
pending on the need and the context, (e.g. a Real-time evaluation
during the implementation of the programme). Evaluations could
be conducted internally or by an external team. Depending on the
context and size of the programme, there may be an evaluation
of only the WASH programme or it might be an evaluation of the
wider programme.
78
INTRODUCTION
Key criteria that are generally used for evaluation humanitarian

action are1:
STEP 1
Relevance/ � Is the hygiene promotion programme relevant
appropriateness to the priorities and policies of the key stake-
holders – the affected population, the NS, the
government?
� Are the activities and outputs of the hygiene
STEP 2
promotion programme consistent with the
overall goal and achieving the objectives
Effectiveness � Have the objectives of the hygiene promotion

programme been achieved?
STEP 3
� What are the factors influencing the achieve-
ment of the objectives?
Efficiency � Efficiency measures the outputs (qualitative

and quantitative) in relation to the inputs.
STEP 4
� Were the hygiene promotion activities cost-
effective?
� Were the objectives achieved on time?
� Was the programme implemented in the most
STEP 5
efficient way compared to alternatives?
Impact � Are there positive and negative changes be-

cause of the programme (directly or indirectly;
intended or unintended).
� What has happened because of the pro- STEP 6
gramme?
� What real difference has the hygiene promo-
tion programme made to the beneficiaries?
STEP 7
STEP 8
1
OECD, DAC criteria
79
The logical framework will form the basis of the evaluation, con-
sidering the inputs (whether the resources were used), the activi-
ties (what was done), the outputs (what was delivered), outcomes
(what was achieved), and impact (the long-term changes).
Both quantitative and qualitative data should be gathered as

part of the final evaluation. As described in Step 5, a Baseline
Survey should be conducted at the beginning of the programme.
Using the same methodology and the same questions, an end-
line survey should be done as part of the evaluation, to assess
changes. If a baseline survey is not conducted and there is no
proper monitoring framework, impact can become very difficult
to prove and measure.
The evaluation should be documented, with a short, clear report

and shared with all the stakeholders, and most importantly, it
must be used; fed back to the community and referenced when
planning future interventions. … .
Monitoring and evaluation play a critical part in showing pro-

gress; but also for learning and improving.
80
INTRODUCTION
Q: H ow can I involve the community in monitoring?

A: We are accountable to the affected population, it is
STEP 1
their programme, so it is important we listen to their
views. Monitoring the programme, the processes, and
outcomes aims to understand what effect the pro-
gramme has had on those affected, as they themselves
STEP 2
see it. The community knows best what has happened
and why, and by involving them they are empowered
to have more control over the programme. However, it
may be difficult for the community to be objective and
STEP 3
they may lack skills and knowledge to carry out moni-
toring. But, there are several ways to get the different
sectors of the community involved (men, women and
children); such as observations, feedback on results
and interpretation in community meeting, keeping
STEP 4
simple tally sheets, pocket chart voting, mapping,
water testing etc. The community level volunteers,
who come from the affected community can play a key
role in monitoring.
STEP 5
STEP 6
STEP 7
STEP 8
81
STEP 8
REVIEW, RE-ADJUST
82
INTRODUCTION
Step 8 Review, Re-Adjust
Step 8: Review, Re-Adjust
STEP 1
The process is iterative, as in every project cycle
where you will go back to your initial assumption
and strategy to re-steer your intervention to
STEP 2
make it more effective and efficient.
Remember to ensure the hygiene promotion pro-

gramme is relevant to the needs. Emergency situations are often
STEP 3
complex, with frequent changes in the situation. Continuous as-
sessment, re-planning and re-adjustment of activities are essen-
tial. Look around! Are there other WASH problems in the affected
community that have not been addressed? Has the problem
STEP 4
changed? Have new problems arisen? If so, go back to Step 1 and
begin again. Annex 1.3 IFRC Guidelines to Hygiene Promotion
in Emergencies quick fix provides a Step by Step guide to the HP
in emergencies with main activities involved and links for addi-
tional information.
STEP 5
Documentation and Handing over
It is important that if the response includes ERUs, it is done in
collaboration with the NS (e.g. in large emergency with RDRT
and ERU teams, they should all work with the NS, helping to STEP 6
strengthen their capacity as needed); all the work should be docu-
mented and shared with the NS, IFRC and other RDRTs and ERUs
working in the disaster response. This will help to avoid duplica-
tion of work and the planning of the follow-up work.
STEP 7
The lessons learnt should be documented and shared as part of

the handover. The documentation does not have to be reports
alone, it can be pictures or short video clips, demonstrating the
STEP 8
way the hygiene promotion has been implemented and the les-
sons learnt.
83
References
WASH CLUSTER. (2007). “Hygiene Promotion in Emergencies –
A briefing paper.” available online from: http://www.unicefine-
mergencies.com/downloads/eresource/docs/WASH/WASH%20
Hygiene%20Promotion%20in%20Emergencies.pdf, accessed 20
May 2016
Sphere. (2011). “Humanitarian Charter and Minimum Standards

in Humanitarian Response.” from http://www.sphereproject.org/
handbook, accessed on May 2016
The Core Humanitarian Standards 2016, https://corehumanitari-

anstandard.org/the-standard
WASH Accountability Resources 2009, Global WASH Cluster,

http://watsanmissionassistant.wikispaces.com/file/view/wash-
accountability-handbook.pdf/353942476/wash-accountability-
handbook.pdf, accessed on 12/01/2017.
Ferron, S., Morgan, J and O’Reilly, M. (2007). Hygiene Promotion:

A Practical Manual for Relief and Development, Practical Action
Publishing.
Br it ish Red Cross (2016), Mass Sanitat ion Module (MSM)

Handbook, a general reference for MSM deployments. http://
watsanmissionassistant.wikispaces.com/file/view/Part%202%20
-%20HANDOUT%20AtB%20in%20MSM%20response%20-%20
minimum%20standards%202013.pdf/608027859/Part%202%20
-%20HANDOUT%20AtB%20in%20MSM%20response%20-%20min-
imum%20standards%202013.pdf
Community, Engagement and Accountability (CEA),

http://watsanmissionassistant.wikispaces.com/file/view/Tool-24-
CEA-brochure.pdf/608027557/Tool-24-CEA-brochure.pdf
84
INTRODUCTION
Step 8 Review, Re-Adjust
WASH CLUSTER (2013). “Training Material.” available online from:

http://washcluster.net/training-resources/ [Access Date: May
STEP 1
2016]
OEDC 2017, DAC Criteria’s for Evaluation development assistance,

OEDC website, http://www.oecd.org/dac/evaluation/daccriteriafor-
evaluatingdevelopmentassistance.htm, assessed on 07/03/2017
STEP 2
Seven Fundamental Principles. http://www.ifrc.org/who-we-are/
vision-and-mission/the-seven-fundamental-principles/
STEP 3
Code of Conduct, http://media.ifrc.org/ifrc/who-we-are/the-move-
ment/code-of-conduct/
Gender in water, sanitation and hygiene promotion- Guidance
STEP 4
note, http://watsanmissionassistant.wikispaces.com/file/view/
Guidance%20note-Gender%20in%20water%20and%20sanita-
tion-EN_LR.pdf/391531082/Guidance%20note-Gender%20in%20
water%20and%20sanitation-EN_LR.pdf
STEP 5
Minimum standard commitments to gender and diversity
in emergency programming (2015), Gender and Diversity in
Emergencies- WASH Programming Standards- Page 23, http://
watsanmissionassistant.wikispaces.com/file/view/Gender%20
Diversit y%20Minimum%20Standard%20Commitments%20 STEP 6
in%20Emergency%20Programming.pdf/608022417/Gender%20
Diversity%20Minimum%20Standard%20Commitments%20in%20
Emergency%20Programming.pdf
STEP 7
ICRC, IFRC (2008), Guidelines to Assessment in Emergencies, IFRC

website, http://www.ifrc.org/Global/Publications/disasters/guide-
lines/guidelines-emergency.pdf, accessed on 07/03/2017
STEP 8
85
Annex
QUICK FIX
IFRC GUIDELINES TO HYGIENE PROMOTION- QUICK FIX
RCRC Defintion of Hygiene Promotion in Emergency

Hygiene promotion (HP) in Emergencies in the Red Cross is defined as: ‘a planned, systematic approach delivered by RCRC staff and
volunteers; to enable people to take action to prevent water, sanitation and hygiene-related diseases by mobilising and engagement of the
affected population, their knowledge and resources; and to maximize the use and benefits of water and sanitation items and facilities’.
HYGIENE PROMOTION IN EMERGENCIES

STEP INCLUDES ACTORS INFORMATION SOURCES
STEP 1: IDENTIFYING Gathering quantitative and qualitative information to under- WASH hardware engineers, community, IFRC Minimum standard
THE PROBLEM stand; what the community knows, does, and understands, other sectors working in the same commitments to gender and
what are their needs, risks, practices and community struc- communities, Government institutions and diversity in emergency programme
tures and the impact of the disaster, by using: other NGOs IFRC Guidelines for Emergency
E xisting Secondary data
� Assessment in English, French,
Mapping
� Spanish, Arabic
FGD with community group (3 pile sorting and pocket

� Sphere Project Water and Sanitation
chart activity) Initial Need Assessment Checklist
Observations and Transect walks

� Transect Walk
Interviews local authorities, other agencies, WASH

� Working with communities:
cluster, RCRC staff and volunteers a Toolbox
STEP 2: IDENTIFYING Identify the target groups together with the community. Community leaders and Health workers, Target group selection
TARGET GROUPS The target groups must include: who is most at risk, the WASH Hardware people, other agencies Gender checklist for WASH
influencers in the community, all sections of community working in the area cluster accountability
(children, older people and people with disabilities) and
special emphasis groups (e.g.: babies/young children)
with different requirements.
ALL DOCUMENTS AVAILABLE at http://watsanmissionassistant.org – in the Hygiene promotion section

STEP INCLUDES ACTORS INFORMATION SOURCES
STEP 3: ANALYSING Gathering information on different motivators and barriers WASH hardware people, beneficiaries, Transmission route
BARRIERS AND to trigger behavior change and eliminate/reduce barriers. Health department staff, Government and Good and Bad behaviors
MOTIVATORS FOR And assessing any reactions, triggers and cultural com- other NGOs
BEHAVIOUR CHANGE patibility and making changes according to the observa-
tions and feedbacks.
STEP 4: FORMULATING Setting objectives for each of the risks identified which can Community leaders and Health workers, IFRC PoA Template – Indicators
HYGIENE BEHAVIOUR be related to hygiene behavior change or enabling factors. Trained HP staff and volunteers, Outcomes, Output and Activities View
CHANGE OBJECTIVES Community group selected for pre-testing.
STEP 5: PLANNING Working with hardware engineers and others to make Trained HP staff and volunteers, Volunteer Management Toolkit
a work plan from the identified objectives and choosing Community focal points and hardware PHAST
output and indicators using a snapshot (survey and other engineers
methods) of the situation. And it also includes: CLTS
Choosing a method or approach and communication Sampling
channels to target different groups
Preparing materials for HP activities (make use of the HP
Box)
Choosing volunteers for HP interventions
Pilot and Pre-test the methods and activities by trying out
it on a small group of people
Make changes and start implementation
Preparing monitoring and reporting plan for the activities
Schedule and conduct the hygiene promotion activities
STEP 6: Following the plan and implementing the activities. The key Trained HP staff and volunteers, Watson & Health NFI Guidelines
IMPLEMENTATION activities are: Community focal points WASH & Health NFI Guidelines
Working with hardware engineers and others to establish IFRC Guidelines to Hygiene Promotion
the needed behavior change communication which goes in Emergencies Trainer’s Manual
along with the WASH facilities
WASH Cluster Training Material
Recruiting and Training the volunteers and staff
IEC Materials
Working together with Relief Teams to give feedback from/
to communities on distribution of HP items
STEP 7: MONITORING Use the HP monitoring forms prepared on Step 5 Trained HP staff and volunteers, Monitoring and Evaluation
AND EVALUATION Collect data again after 3 months compare with the initial Community focal points
baseline data from Step 1 and evaluate.
Make changes to HP work plan to address the hygiene
behavior objectives of the new scenario
STEP 8: REVIEW, Follow the changes to the situation and re-plan and re- Trained HP staff and volunteers,
RE-ADJUST adjust to address the current problems. Community focal points and hardware
engineers
The Fundamental Principles of the International
Red Cross and Red Crescent Movement
Humanity The International Red Cross and Independence The Movement is independ-
Red Crescent Movement, born of a desire to ent. The National Societies, while auxiliaries
bring assistance without discrimination to in the humanitarian services of their gov-
the wounded on the battlefield, endeavours, ernments and subject to the laws of their
in its international and national capacity, to respective countries, must always maintain
prevent and alleviate human suffering wher- their autonomy so that they may be able at
ever it may be found. Its purpose is to protect all times to act in accordance with the prin-
life and health and to ensure respect for the ciples of the Movement.
human being. It promotes mutual under-
Voluntary service It is a voluntary relief
standing, friendship, cooperation and lasting
movement not prompted in any manner by
peace amongst all peoples.
desire for gain.
Impartiality It makes no discrimination as
to nationality, race, religious beliefs, class or Unity There can be only one Red Cross or Red
political opinions. It endeavours to relieve the Crescent Society in any one country. It must
suffering of individuals, being guided solely be open to all. It must carry on its humani-
by their needs, and to give priority to the tarian work throughout its territory.
most urgent cases of distress.
Universality The International Red Cross
Neutrality In order to enjoy the confidence of and Red Crescent Movement, in which all
all, the Movement may not take sides in hostili- societies have equal status and share equal
ties or engage at any time in controversies of a responsibilities and duties in helping each
political, racial, religious or ideological nature. other, is worldwide.
For more information on this IFRC publication,
please contact:
International Federation of
Red Cross and Red Crescent Societies
WASH Unit Geneva
wash.geneva@ifrc.org
www.ifrc.org
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WASH guidelines for hygiene

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Table of contents WASH guidelines for hygiene promotion in emergency operations

Step 1: Identifying the Problem20

WASH guidelines for hygiene promotion in emergency operations

Table of contents WASH guidelines for hygiene promotion in emergency operations

1. IFRC Guidelines for Hygiene Promotion in Emergencies (this

2. A 16-page summar y of the IFRC Guidelines to Hyg iene

3. A short one-page summary of the IFRC Guidelines to Hygiene

4. A training manual to help put these IFRC Hygiene Promotion

WASH guidelines for hygiene promotion in emergency operations

Introduction WASH guidelines for hygiene promotion in emergency operations

This document is summarised in a short six-page document and STEP 6

ence material mentioned in the documents are linked and will be

WASH guidelines for hygiene promotion in emergency operations

Who is this document for?

The specific target audience are hygiene promoters who may

What is Hygiene Promotion and why is it important

Hygiene promotion (HP) in Emergencies in the Red Cross is defined as:

The main aim of a WASH intervention is to prevent and reduce

Health of individuals and communities are influenced by many

Introduction WASH guidelines for hygiene promotion in emergency operations

hygiene facilities is part of hygiene promotion, along with influ-

 Safe disposal of excreta

WASH guidelines for hygiene promotion in emergency operations

But it is not limited to these alone, other issues such as vector

Figure 1: H ygiene Improvement Framework (Source: Sphere

Introduction WASH guidelines for hygiene promotion in emergency operations

the F chart and agree on which barriers can be placed to break

Key components of Hygiene Promotion are:

Use and Feedback to/from the engineers or com-

Selection and Working with the community on the type

Community Using principles of behaviour change

Communication Collaborate with Government, other or-

Monitoring The use and the community’s satisfaction

For more information on these points refer to the WASH Cluster

Hygiene Promotion briefing paper. All RC WASH programmes

WASH guidelines for hygiene promotion in emergency operations

Principles and Standards

There are two standards for Hygiene Promotion in the Sphere

Sphere Standard 1: Hygiene promotion implementation

Sphere Standard 2: Identification and use of hygiene items

As the Sphere handbook states Hygiene Promotion gives the af-

Introduction WASH guidelines for hygiene promotion in emergency operations

-- Dissemination of one-way messages -- Practical action that people can take

for people to clarify issues and work

Community mobilisation is especially appropriate during disas-

ters as the emphasis must be on encouraging people to take ac-

WASH guidelines for hygiene promotion in emergency operations

where possible, interactive methods rather than focusing exclu-

The WASH cluster Accountability Project developed some simple

It is strongly encouraged for hygiene promoters to read the booklet

The Core Humanitar ian Standard (CHS) on Qualit y and

Introduction WASH guidelines for hygiene promotion in emergency operations

affected by crisis at the centre of the humanitarian action and

A: Whilst we may lack academic evidence to demon-

WASH guidelines for hygiene promotion in emergency operations

How to implement Hygiene Promotion in emergencies?

The implementation of the Hygiene Promotion programme fol-

Step 1: Identifying the Problem20

1. IFRC Guidelines for Hygiene Promotion in Emergencies (this

2. A 16-page summar y of the IFRC Guidelines to Hyg iene

3. A short one-page summary of the IFRC Guidelines to Hygiene

4. A training manual to help put these IFRC Hygiene Promotion

Safe disposal of excreta

Figure 1: H ygiene Improvement Framework (Source: Sphere

A: Whilst we may lack academic evidence to demon-

Figure 2: Hygiene promotion project cycle (Source: WASH Cluster,

Q: W hat are the challenges of when doing a Rapid

Q: Should the team wait until the assessment is com-

A: No, if there are immediate urgent needs, the response

Step 2 Identifying Target Groups

Step 2 Identifying Target Groups

Q: In an outbreak of cholera everybody in a community is

A: Yes, in a cholera outbreak, hygiene promotion is im-