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05 December 2018

Camp Hygiene Promotion Campaigning in Later-Stage Emergencies

Author/Compiled by
Luisa Muenter (cewas)
Executive Summary

Throughout the stages of a humanitarian crisis, refugee populations and Internally Displaced People (IDPs) in camps must be safeguarded against water, sanitation and hygiene (WASH)-related diseases through systematic and participatory hygiene promotion campaigns. In contrast to early-stage emergencies, where hygiene promotion campaigns focus on addressing the riskiest practices for diarrheal diseases transmission, hygiene promotion campaigns in later-stage emergencies address a wider scope of risk factors and hygiene issues, including environment-related diseases. The range of communication and participatory methods and approaches, too, are more diversified. This factsheet provides guidance for hygiene promotion campaigns in later-stage emergencies. It details the relevant components of a hygiene promotion campaign and explains the relevant working steps for implementation, monitoring and ongoing assessment of the situation.

Advantages
Facilitates guidance for coordinating a response between humanitarian actors;
Promotes increasing participation and community mobilisation which will enable real behaviour change of the refugee and IDP population and will improve sustainability of the intervention;
Hygiene promotion campaigns are pivotal to water supply and sanitation interventions;
Provides clarity and concrete steps to approach soft- and hardware approaches.
Disadvantages
Coordination with water, sanitation, and health required for hygiene promotion planning and for dissemination of harmonised information can be challenging;
In can be costly to properly plan a hygiene promotion campaign and specific skills are required.
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Introduction
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Systematic and participatory planning approaches are needed to implement effective hygiene promotion campaigns in camps during early- and later-stage emergencies. They promote positive behavioural change around household, food and personal hygiene and facilitate meeting the The Sphere Project StandardsMinimum Standards (UNHCR 2015, THE SPHERE PROJECT 2011, GWC 2009). Careful planning, execution, monitoring and evaluation will ensure humanitarian actors can provide appropriate support and refugees and Internally Displaced People (IDPs) are empowered with the knowledge, resources, willingness and practice to prevent diseases of concern in camps and prolonged encampment settings (HARVEY 2015, WHO AND WEDC 2011).

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Addressing the Later Emergency Stage
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Depending on the stage of the humanitarian crisis (e.g. early emergency, later/post-acute emergency, or prolonged, protracted crisis), hygiene promotion strategies vary in terms of intensity and scale of the intervention (GWC 2009).

In later-stage emergencies, the situation is usually already well assessed and more time is available for hygiene promotion activities. The breadth of issues covered by hygiene promotion campaigns can therefore be expanded from the most pressing issue of diarrheal diseases prevention to also address other hygiene concerns and risk factors such as transmission of environment-related diseases (IOM, NRC AND UNHCR 2015, HARVEY 2015, WHO AND WEDC 2016).

As the situation stabilises in the later emergency stage, refugees and IDPs can increasingly participate in the design and management of WASH services as well as in disease prevention (HARVEY 2015). Accordingly, the range of communication and collaboration platforms and approaches should be diversified to also include Media Campaigns - Radio (DC)/TV broadcast, public announcements, Media Campaigns - Posters and Flyers (DC), signs, paintings and cartoons (see Creating Information Material (DC) factsheet), meetings and Focus Groups, celebrations, traditional and community events, film and video presentations, as well as dramas, role plays, games and songs (IOM, NRC AND UNHCR 2015). The communication methods should always be chosen based on an assessment of the cultural norms of the refugee/IDP population through consultation and participation. 

 

Working with children on creating key messages blitzing cards. Source: ACTED (2016).   

Working with children on creating key messages blitzing cards. Source: ACTED (2016).   

Positive Behavioural Change and Community Engagement around Hygiene in Later Emergency Stages

Camps, where investments in behavioural change programs were made during the emergency phase, often see the population practising good hygiene behaviour for many years. Investment in behavioural change interventions are therefore a cost-effective and sustainable method of intervention and thus very relevant for later-stage emergencies (CRONIN ET AL 2008). As such, the later emergency stage is a key time to focus on community mobilisation and to engage the community through participatory processes such as Participative Hygiene and Sanitation Transformation (see invalid link factsheet).

Hygiene Committees or Health Clubs

All WASH programs should have hygiene committees or health clubs developed and run in cooperation with the refugee and IDP population and the host communities (UNHCR 2015b). Community-based WASH committees can encourage and support refugee populations to take an active role in operations and maintenance of sanitation facilities, which helps to safeguard good hygiene in the longer term (IOM, NRC AND UNHCR 2015). All programs should have gender-balanced and representative committees that are responsible for promoting hygiene and implementing hygiene promotion campaigns. If such committees are set up, clear roles, responsibilities, rules and regulations must be defined for both professional hygiene promoters and community mobilisers from the refugee / IDP population (see invalid link factsheet). Additionally, hygiene promotion should be coordinated with education efforts and opportunities should be sought to carry out hygiene promotion in schools (see School Campaigns (DC) factsheet) (HARVEY 2015).

Volunteer Hygiene Promotion training in Al Koom Quneitra Syria. Source: MEREE (2015).        

Volunteer Hygiene Promotion training in Al Koom Quneitra Syria. Source: MEREE (2015).        

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Planning and Preparation – A Phased Approach
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Mobilising the community for hygiene promotion is best done in a phased approach that is adapted to the stage of the emergency or humanitarian crisis (HARVEY AND CONOLI 2015). In the immediate emergency phase, hygiene promotion should focus on (HARVEY AND CONOLI 2015):

  • Ensuring necessary resources are provided to the refugee/IDP population to carry out proper hygiene.
  • Mobilising the community to act to address WASH-related problems.
  • Mobilising the community to act concerning the design, use, management of WASH services.
  • Ensuring that the refugee population has the basic knowledge to prevent disease.

In the medium- to long-term post-emergency phase, on the other hand, hygiene promotion should follow an approach more in line with development settings, involving continuous assessment, analysis, design, implementation, monitoring and evaluation of risks (a concept commonly referred to as Linking Relief, Rehabilitation and Development LRRD) (HARVEY 2015).

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Steps in Hygiene Promotion Campaigning
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Generally, there are two crucial matters in hygiene promotion campaigning that must be carefully plan for: 1) the distribution of hygiene sanitary products and cleaning tools or the availability of latrines (Sphere Standard 2) and 2) the implementation of a hygiene program (Sphere Standard 1) (IOM, NRC AND UNHCR 2015, THE SPHERE PROJECT 2011). The following steps should be taken when carrying out a hygiene promotion campaign in later-stage emergencies:

Defining the Campaign Strategy

Every camp should have a context-specific hygiene promotion strategy in place that justifies “WHY hygiene promotion is important in the specific context, HOW the key hygiene risk practices have been identified, WHO are the priority at-risk groups and WHY, WHAT are the most effective hygiene promotion approaches and activities and WHY, HOW the target activities for each at-risk group will carry out and HOW the effectiveness of the plan will be monitored’’ (HARVEY 2015). If the strategy has not been set out during the early emergency stage, this should be rectified as soon as possible during the later emergency stage. The following components should be addressed by the strategy and prioritised according to a continuous risk (re-)assessment: community and individual action, Ensuring Appropriate Operations and Maintenance Services,Selecting and Distributing Hygiene Items, monitoring, community participation and communication with WASH stakeholders.

Planning and Preparation

The six planning and preparation steps for hygiene promotion campaigns (assessment, consultation, initial planning through goals and objectives, planning through target audiences and stakeholders, planning of communication campaigns and modes of intervention and recruiting, identification and training of field workers and outreach systems) are usually carried out during the early emergency stage (see Camp Hygiene Promotion Campaigning in Early-Stage Emergencies factsheet). The later emergency stage, on the other hand, focuses on implementation, monitoring and adaptation.

Implementation, Monitoring and Adaptation

While Hygiene Promotion and Community Mobilisation in Camps focuses on planning and preparation, activities in later emergency stages primarily focus on ensuring that the hygiene promotion campaign continues to work towards meeting its goals and objectives and adapts to the changing needs of the refugee and IDP population (adapted from GWC 2009 and HARVEY 2015):

Implementation and ongoing assessment of the situation
  • Conduct ongoing assessments to understand the motivation factors behind positive behaviour change around hygiene.
  • Obtain quantitative data and carry out a systematic data collection in a participatory manner and in coordination with other sectors.
Monitoring
  • Monitor the hygiene promotion activities (e.g. distribution of hygiene kits, installation of toilets) and people’s level of satisfaction.
  • Monitor and evaluate hygiene promotion campaigns against hygiene-related indicators on safe access to quality sanitation and on satisfactory living condition (UNHCR 2015). The relevant indicators for the later emergency stage include:
    • ≥ 90% of households have soap present in the house (which can be presented within 1 minute),
    • ≥ 80% of households are can name 3 of the 5 circumstances in which it is critical to wash hands
    • ≤ 500 refugees/IDPs per hygiene promoter
    • Availability of 450 grammes/person/month of soap. Actual needs are to be determined based on monitoring results.
Adaptation
  • Refine the campaign based on the changing situation and move towards more interactive methods of communication and participation in comparison to earlier emergency stages.
  • Rapidly adapt the intervention and campaign based on monitoring outcomes and empower the communities to maintain their longer-term hygiene promotion structure (e.g. committees).
  • Continue training and monitoring and adapt approaches as necessary.
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Planning Timelines
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Hygiene promotion plans should be revised every six months based on monitoring outcomes (HARVEY 2015).

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Applicability
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The guidance is applicable to later emergency stages in Camps or collective settlements.

Library References

A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators – the need for integrated service provision

International Organization for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR)`s Camp Management Toolkit provide tools and approaches to provide concrete guidance on facilitating hygiene improvement in an acute, early stage of an emergency relevant to camps. This toolkit is applicable to both IDPs and refugees living in communal settings.

CRONIN, A. ; SHRESTHA, D. ; CORNIER, N. ; ABDALLA, F. ; EZARD, N. ; ARAMBURU, C. (2008): A review of water and sanitation provision in refugee camps in association with selected health and nutrition indicators – the need for integrated service provision. In: Journal of Water and Health: URL [Accessed: 26.10.2016]

Hygiene Promotion in Emergencies

This Global Wash cluster manual provides training materials and handouts for facilitators to train hygiene prompters. It contains advice on hygiene promotion related non-food items selection and delivery. The WASH related non-food items briefing paper addresses maximizing benefits of the distribution of hygiene items, selection of hygiene items, guidance on distribution and tips for improving distribution of items, as well as suggestions for improved coordination.

GWC (2009): Hygiene Promotion in Emergencies. A Briefing Paper. New York: Global WASH Cluster URL [Accessed: 08.11.2016]

Chapter 8: Hygiene Promotion

This briefing paper provides basic information on Oxfam`s hygiene kits. It introduces the types of hygiene practices that are enable through the items in the kits and prices details on the contents of Oxfam’s basic hygiene kit.

HARVEY, B. (2015): Chapter 8: Hygiene Promotion. In: HARVEY, B. ; (2015): UNHCR WASH Manual. Geneva: . URL [Accessed: 25.11.2016]

Camp Management Toolkit

International Organisation for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR)`s Camp Management Toolkit provide tools and approaches to provide concrete guidance on facilitating hygiene improvement in an acute, early stage of an emergency relevant to camps. This toolkit is applicable to both IDPs and refugees living in communal settings.

IOM NHCR UNHCR (2015): Camp Management Toolkit. Genva: International Organization For Migration URL [Accessed: 25.08.2016]

Hygiene promotion in emergencies

This guidance document is for managers of WASH programs to manage their hygiene promotion campaigns programmes. This clear and well-presented guidance document provides background information for hygiene, hygiene practices in camps, and the F-diagram. It also concisely summarises types of evaluation and monitoring. It presents pertinent information on principles of hygiene promotion, selection and training facilitators, methods of hygiene and sanitation promotion, planning guidance for hygiene promotion campaign and method of implementing a plan of action. Further guidance is provided on how to analyse assessment information and available participatory tools that may be used.

WHO WEDC (2011): Hygiene promotion in emergencies. In: WHO ; WEDC ; (2011): Technical Notes on Drinking-Water, Sanitation, and Hygiene in Emergencies. Geneva: . URL [Accessed: 04.11.2016]
Further Readings

Gap Analysis in Emergency Water, Sanitation and Hygiene Promotion

This is a gap analysis report which analyses emergencies situations to identify over 50 programming gaps in the areas of water, sanitation and hygiene. The most hygiene promotion related significant gaps included the importance of understanding the context and weak community participation.

BASTABLE, A. RUSSEL, L. (2013): Gap Analysis in Emergency Water, Sanitation and Hygiene Promotion. Oxford: Humanitarian Innovation Fund URL [Accessed: 08.11.2016]

Water, Sanitation, and Hygiene in Emergencies

The International Red Cross’s Health Guide Book provides a chapter providing guidance to improving water, sanitation, hygiene and vector control in emergency settings. It provides information on assessing needs in different phases, identifying the vulnerable group, and determine diseases to target. It provides guidance on disease transmission, community involvement in disease prevention with detail on the requirement in early emergencies phases.

JOHN HOPKINS UNIVERSITY IFRC (2008): Water, Sanitation, and Hygiene in Emergencies. Baltimore: John Hopkins University URL [Accessed: 14.11.2016]

A Review of Evidence-based for WASH Interventions in Emergency Response/Relief Operations

This review discusses evidence on different approaches to Water, Sanitation, and Hygiene interventions contrasting the development context to the emergency content. Using reviews of cases, the report discusses the types of hygiene promotion interventions commonly applied and the approaches commonly applied. The report details the shift towards trend towards integrated approaches to after, sanitation, and hygiene. Requirements for effective hygiene promotion in emergencies are explored for different approaches to hygiene promotion as well as programming and implementation issues.

PARKINSON, J. (2009): A Review of Evidence-based for WASH Interventions in Emergency Response/Relief Operations. London: Atkins URL [Accessed: 14.11.2016]

Hygiene promotion in emergencies

This guidance document is for managers of WASH programs to manage their hygiene promotion campaigns programmes. This clear and well-presented guidance document provides background information for hygiene, hygiene practices in camps, and the F-diagram. It also concisely summarises types of evaluation and monitoring. It presents pertinent information on principles of hygiene promotion, selection and training facilitators, methods of hygiene and sanitation promotion, planning guidance for hygiene promotion campaign and method of implementing a plan of action. Further guidance is provided on how to analyse assessment information and available participatory tools that may be used.

WHO WEDC (2011): Hygiene promotion in emergencies. In: WHO ; WEDC ; (2011): Technical Notes on Drinking-Water, Sanitation, and Hygiene in Emergencies. Geneva: . URL [Accessed: 04.11.2016]
Case Studies

In Kenya’s refugee camps, hygiene promotion aims to prevent disease by changing behaviour

In Kenya at the Hagadera refugee camp, local hygiene promoters from the Somali refugee population are active in promoting the importance of good hygiene practices. The hygiene promoters work with UNICEF using a strategy which includes working to continually improve hygiene practices. The hygiene promoters are active in schools and are assisting the population in developing themselves. They reinforce positive behavioural change through daily contact with the refugee population. UNICEF provides ongoing support through the ongoing provision of hygiene items and the ongoing training of hygiene promoters to lead behaviour change as a vital barrier to disease.

MORENO, M. (2011): In Kenya’s refugee camps, hygiene promotion aims to prevent disease by changing behaviour. Nairobi: UNICEF URL [Accessed: 10.11.2016]

Hygiene Promotion in Mwange Camp

The hygiene promotion in this Mwange camp in Zambia was implemented through the WATSAN. It was a success as it convinced the refugee population that hygiene was a priority. The project was based on approaches designed to build community will and decision-making power in individuals, families, and within the communities. It built the capacity of refugees in the operation and maintenance of the systems that were established and developed. The project worked to ensure the affected populations became aware of priority hygiene practices and had adequate information and resources to protect and enhance their health. Through assessment, the project identified hygiene promotion was marginalised by health professionals in preference of other cases and to meet immediate needs and that latrines design was not compatible with religious beliefs. To address this, hygiene promoters (preferentially women) were trained to fill this gap and the latrines were redesigned. The hygiene promotion programme used multiples avenues to promote handwashing, use of latrines, and waste disposal. Incentive programs were used to encourage good practices and it was found the practices continued after the incentives ran expired.

PHIRI, S. (2001): Hygiene Promotion in Mwange Camp. Lusaka: Red Cross Society URL [Accessed: 19.11.2016]
Training Material

Hygiene Promotion in Emergencies

This Global Wash cluster manual provides training materials and handouts for facilitators to train hygiene prompters. It contains advice on hygiene promotion related non-food items selection and delivery. The WASH related non-food items briefing paper addresses maximizing benefits of the distribution of hygiene items, selection of hygiene items, guidance on distribution and tips for improving distribution of items, as well as suggestions for improved coordination.

GWC (2009): Hygiene Promotion in Emergencies. A Briefing Paper. New York: Global WASH Cluster URL [Accessed: 08.11.2016]

Camp Management Toolkit

International Organisation for Migration (IOM), Norwegian Refugee Council (NRC) and UN Refugee Agency (UNHCR)`s Camp Management Toolkit provide tools and approaches to provide concrete guidance on facilitating hygiene improvement in an acute, early stage of an emergency relevant to camps. This toolkit is applicable to both IDPs and refugees living in communal settings.

IOM NHCR UNHCR (2015): Camp Management Toolkit. Genva: International Organization For Migration URL [Accessed: 25.08.2016]
Awareness Raising Material

Water, Sanitation, and Hygiene

The Norwegian Refugee Council introduces the field of water, sanitation, and hygiene in humanitarian crises. It provides an overview of what humanitarian actors activities in the field can include and provides relevant news on the humanitarian crises and humanitarian aid interventions.

NRC (2017): Water, Sanitation, and Hygiene. Oslo: Norwegian Refugee Council URL [Accessed: 01.05.2016]

Alternative Versions to