National Hand Washing Campaign Launched

By Young Samanyika

The Minister of Health, Honourable Dr Jean Kalirani, MP, on Thursday, 10th November, 2011, launched National Hand Washing Campaign at Kalambo Full Primary School ground in Area 25 in Lilongwe.The launch ceremony was also attended by other senior officials from the Ministries of Health, Water development, Education, Local Government; traditional leaders, Malawi National team coach (as Good will ambassador), teachers and pupils.

The launch ceremony was preceded by the campaign concept brief by the Ministry of Health and UNICEF to prospective doners and partners of the campaign. This was felt necessary as one way of soliciting funding and support in any kind towards the campaign, as no steady funding of the campaign has been secured.

From right Deputy Director Mr Masuku, PS Dr Charles Mwansambo,Minister of Health Dr Jean Kalirani

The presenter was the Principle Environmental Health Officer responsible for water, sanitation and hygiene, Mr Young Samanyika, who is also the coordinator of the campaign.This session was attended by representatives from DFID, USAID, Save the Children, Standard Bank, Water Aid, Arkay Plastics Limited and other Non Governmental Organisations.
 

Diarrhoea and pneumonia are the second leading cause of death among children of under five globally. Nearly one in five child deaths, about 1.5 million each year, is due to diarrhea and the same with pneumonia. Each one of these (diarrhoea and pneumonia) kills more young children than AIDS, malaria and measles combined.

In Malawi, diarrhoea and pneumonia are the third and second cause of deaths and illnesses among children of less than five years respectively. In 2010 alone, 224,354 under five cases of diarrhoea with 369 deaths and 860,809 under five cases of Acute Respiratory Infections (ARI) with 958 deaths were reported from the primary and secondary health care levels.
Prevention of diarrhoea and pneumonia can therefore contribute significantly in meeting Millennium Development Goal (MDG) number four which is aiming at reducing deaths in under five children by two thirds by 2015.  Currently, the Child Mortality Rate (CMR) in Malawi is at 118 per 1,000 live births and Infant Mortality Rate (IMR) is at 69 per 1,000 live births . If Malawi is to achieve MDG 4 then it is expected to cut the CMR and IMR to 39 and 23 per 1,000 live births respectively.

There are many interventions that are being implemented at different degrees to address the high CMR in Malawi including immunisations, hygiene education, safe water supply, household water chlorination, oral rehydration, promotion of breast feeding, and sanitation and hygiene promotion. Another intervention which is so powerful but given inadequate attention is Hand Washing With Soap (HWWS).

HWWS is rated as the single-most cost-effective health intervention.  It only takes  $3.35 (about £2.1) to yield one unit improvement on the Disability-adjusted life years (DALYS) scale which is the cheapest as compared to all other interventions like: Cholera immunizations that requires $1,658 to $8,274; Rotavirus immunizations that requires $1,402 to $8,357
Measles immunization $257 to $4,565; Oral rehydration therapy $132 to $2,570; Breastfeeding promotion programs that $527 to $ 2,001; Latrine construction and promotion that requires <$270; House connection water supply that requires $223.00; Water sector regulation and advocacy that requires $47.00 and Latrine promotion that requires $11.15 to earn the same one unit of improvement.on the other hand it has also been observed that HWWS is among the most effective and inexpensive ways for preventing diarrhoeal diseases and pneumonia, which together account for 3.5 million child deaths annually .

A review of more than 30 studies found that HWWS cuts the incidence of diarrhoea by nearly half. Evidence also suggests that HWWS reduces the rate of respiratory infections by about 25 percent. A study in Pakistan found that HWWS reduced the number of pneumonia-related infections in children under the age of five by more than 50 percent. Other studies have shown that HWWS reduces the incidence of skin diseases; eye infections like trachoma; and intestinal worms, especially ascariasis and trichuriasis and enteric viruses. HWWS is, therefore, a cornerstone of public health as it breaks the transmission cycle by removing pathogens that infect  people via hands that have been in contact with faeces and  other body secretions, contaminated drinking water, unwashed raw food and unwashed utensils or smears on clothes.

Despite having all these success stories about HWWS, little is done in reinforcing scaling up of this intervention. Evidence of actual hand washing practice is scanty but studies in rural areas suggest that the actual practice of HWWS at key times is about 2%. Observations in Malawi show that HWWS promotion is undertaken as an adhoc activity both at national and local level. Current efforts to promote good hygiene and HWWS in particular, have not been sufficient to bring about mass behaviour change on the scale that is needed.  Efforts producing piecemeal village-by-village and pilot approaches have had some impact in Malawi but nothing on a large or national scale has been attempted.  

This idea of NHWC, therefore, was developed to make sure that activities for promotion of HWWS become comprehensive as changing behaviour is not easy. However on the other hand it is encouraging to note that once habits are formed, are hard to break.This campaign will help transforming the piecemeal and ad-hoc efforts into a single well coordinated comprehensive intervention. It is only after such an endeavour that impact of HWWS could be fully realised.

The campaign will also complement the global efforts of promoting HWWS, whereby Global Hand Washing Day (GHWD) was already declared on every 15th October, by extending the practice from being a single day’s activity into a routine, all year round behaviour thereby forming people’s habits.The NHWC would also help in raising awareness, enhancing political commitment and resource allocation for hygiene.  It will offer a route to a coordinated national programme where efforts will no longer be piecemeal, but combined under one umbrella, and use high-profile and up-to-date approaches aimed at changing the one specific hygiene behaviour that has been shown to be the most cost-effective in reducing the disease burden.

The campaign will also be in line with WHO and UNICEF 7-point plan to reduce childhood diarrhoea deaths, as well as a prevention package to making a lasting reduction in the diarrhoea burden in the medium to long term.

The main of objective of the Campaign is to accelerate the adoption of hand washing with soap behaviour in Malawi especially among the vulnerable groups (the poor, mothers & caregivers, and young children).Specifically, by the end of one year, the campaign is aiming at: Increasing number/proportion of school children practising HWWS; Increasing number/proportion of mothers and care givers practising HWWS; Reaching the general public with HWWS messages; and engaging active participation of private sector in promotion of hand washing with soap.

The National Campaign, as outlined in the objectives, will target almost everyone as no-one will be excluded from the messages. However, diarrhoeal disease is far more common and more dangerous in young children, and therfore, the primary target group for the hygiene promotion is mothers of these children, particularly mothers from rural homes and women in general as female members of the community contribute to child care. However, children in pre-schools such as Community Based Childcare Centres (CBCCs) and primary schools form the other key target group in two respects: 1) their habits can be moulded at a young age, and 2) they can be used as agents of change by reinforcing the selected hygiene practices within their home environment.

Nevertheless male members should not be ignored as it is usually the male head of household who controls expenditure and makes decisions that affect all household members.  They can also be supportive of the whole process, particularly, when it comes to mobilizing for a social marketing campaign.Other groups that need to be targeted are all the partners who are involved in the social marketing campaigns.  This target group includes intermediaries and potential change agents such as opinion leaders, teachers, religious and traditional leaders, public representatives, women leaders, health and family planning functionaries/volunteers, neighbours, traditional healers and birth attendants, NGOs, CBOs, private sector manufacturers and suppliers.  Technicians responsible for construction of water supply and sanitation facilities and those in charge of operation and maintenance of facilities also form an important target group for hygiene promotio

The campaign will promote hand washing at critical times such as: Hand Washing with Soap before Preparing food (particularly for infants and breastfeeding) and  Eating; Hand Washing with Soap after Visiting the toilet and Cleaning a baby’s bottom

NHWC will try to coorporate emotive methods, on top of the traditional methods, that will trigger disgust of unwashed hands e.g. agar plates demonstrating two pairs of hands that look clean, one pair HWWS and the other not but still contains germs and use Hand Washing demonstration kits.

(Left) HWF designed by primary school pupils

The campaign will also use a “Social Marketing” and other participatory approaches like Participatory Hygiene and Sanitation Transformation (PHAST). Social Marketing will pay attention to the `consumer' by understanding their behaviour, investigating the determinants of current behaviours and sub¬sequently designing an intervention that is culturally appropriate and uses communication messages that make sense to the population.The private sector will be crucial on

this part to make sure that devices that facilitate the selected hygiene behaviours are are available widely at good value. PHAST will assist communities understand their problems, plan and implement activities that will promote HWWS through conducting community dialogue sessions using participatory methods like Focus Group Discussions.
Health Education Band Perfoming

Health facilities are one of the places that are visited by many people including mothers. It is also at these places that those who suffer from the consequences of not following hygiene practices report remedial assistance and above all health facilities are bases for hygiene promoters. If the proverb that says “actions speak louder than words” then all health facilities must have adequate hand washing facilities for both health workers and clients and all health workers must be using them so that they should act as role models. This should also be the case wherever a health worker is staying.
                                                                                                         
To sum it all, the campaign will use Multiple Communication Channels for Behaviour Change and 

various Information, Education and Communication materials. These channels will include:Television and radio jingles;Newspaper and bill board advertisements; Cell phone messages; Rallies and demonstrations on hand washing with soap in communities, at schools, health facilities and public

  Minister of Health (Blue) National Team Coach Kinna Phiri (Red) giving presents to winning Schools

places across the country; and Supplying HWWS commodities like soap and hand washing facilities through public-private partnerships.

Pictorial Focus

  Primary school Pupils appreciating hand wasing facilities

References
 1. http://www.who.int/mediacentre/factsheets/fs178/en/index.html 4/02/2011
 2. Ministry of Health, 2010, Health Management Information Systeme (HMIS) Report, Lilongwe.
 3. National Statistics Office & UNICEF, 2006, Multiple Cluster Survey,
 4. UNICEF, 2009, Soap, Toilets and Taps