OpenIDEO is an open innovation platform. Join our global community to solve big challenges for social good. Sign Up / Login or Learn more

My Clean Little Hands: Applying Social marketing to build a culture of hand washing in children.

This idea aims at instilling the culture of hand washing among children as early as one year when they start understanding so that the habit grows in them as they grow older. This project through promotion of hand washing will contribute to better ECD outcomes by cutting off the constant ingestion of faecal matter by children 0-5 years. It is often difficult for grown-up adult mothers and other caretakers to take up the behavior of hand washing at critical times. The project will encourage caretakers in Uganda to actively train their infants and young children to always keep their hands clean by washing them with water and detergents or or other acceptable cleansing agents at critical times.

Photo of International Youth Empowerment Network
46 30

Written by

 

Key findings from focus group discussions and key informant interviews with caretakers, community leaders and government representatives

 


Hopes and Dreams caretakers have for their children:

All the caretakers in the focus groups wished to nurture their children well so that they can are successful and are great life achievers later when grown up into adults.  Through successful children caretakers hoped they could gain more status and recognition within their communities, live happier old age lives and leave legacy behind. The main nurturance the caretakers said are providing to the children zero to five includes encouraging the children to be creative so that they can come up with ideas for making money, fending for their education and health needs, training children to be have healthy practices and acting as role models for the children. Some of the outstanding quotes from the discussions are provided:

  • “I want my child to be creative so that she can come up with ideas for making money and I feel good and proud”, female respondent in Balintuma zone, Kiwatule.
  • “I want my child to grow healthy, does not fall sick and is healthy, their hair is not brown”, respondent in Sebowa zone, Kiwatule
  • “For God to give him knowledge and study, then get a job after but not to finish studying and sit back at home’, female respondent in Kiwologoma village, Kira.
  • “I want my child to be a health educator so that he can guide a lot of people just like the job you are doing”, respondent in Kiwologoma!
  • “I want my child to be a health worker because it is motivating when my child is helping other people in the community”, Balintuma focus group.
 
Perceptions and opinions caretakers have on the proposed My Clean Little Hands project:
All the caretakers were optimistic about the project as they saw it as being important in helping their children grow up washing their hands at all times as a healthy practice.
  • “It is a good project because these children will always know that it is healthy to wash their hands all the time”, focus group discussant said.
Caretakers believe it is good for children to know that every time they touch anything dirty they have to clean their hands by washing them.
 
  • “It is very good because if a child understands that after touching anything dirty, I have to wash my hands, before eating anything, I have to wash my hands, after visiting the toilet, I have to wash my hands, the child grows with the behavior of washing hands”, focus group discussant in Sebowa.
The most critical times for hand washing for children that the caretaker identified are after visiting the toilet, after playing, before and after eating food and in the morning as they wash their faces.

The caretakers are convinced if they actively taught their children to always wash their hands, then the practice could help prevent their children from getting sick of intestinal worms, cholera, dysentery, cough and diarrhoea. In the long run the practice could save parents from spending lots of money on treating their children due to diseases spread through ingestion of dirt.

Perceptions and opinions community leaders and local government representatives have on the proposed project:
  • It is a good idea because it will keep our children healthy and attend schools all the time. More especially when you make the habit interesting like inform of Drama so that it’s interesting to these children.
  • This is a good project because we also emphasize hygiene here in this school through encouraging these children to wash their hands every time they visit the toilet and before they eat the food.
  • This would actually work if we can get support on the facility because right now there are jerry cans of water we put near the class room and the dining room thus it would be of great help if we had a tap and soap.
  • “It’s a great project that I would welcome with both hands but why are you targeting the under fives looking at them as being too young to understand? In my opinion you should target the caregivers and the parents in this case because they are the implementers at the end of the day. What I mean is that the information has to go through the care givers but not directly to these little young children. i.e. the maids because they spend most of the time with these children and also the kindergarten teachers for they play a big role in grooming these children”, health inspector, Kira Town Council. 

How caretakers feel when their children have diarrhoea:
  • “I feel very bad because I have to sleep in the hospital all the time as my husband is taking care of the other children at home all night and the father takes care of the sick child as I go home to rest. Thus, it is really tiresome”, lamented a female respondent
  • “I feel disturbed but I run to the VHT for treatment and she refers when she cannot handle”, reported a respondent. 

 

Feelings related to eliminating diarrhoea in children
  • I would feel good and happy because the child can have diarrhoea and you feel like giving up on him/her.
  • I would feel good because I wouldn’t have to worry any more about my child being sick.
  • I wouldn’t be worried about staying awake all the time taking care of my sick child.
  • It would be good but it is very impossible due to these stages that the child has to go through and have diarrhoea

 

The difference elimination of diarrhoea in children would make in the community
  • The community would be healthy and developmental
  • We would be saving money which is spent on treatment.
  • We would have peace all the time and think of other things to do other than thinking about the sick child.

 

Whom the caretakers turn to when their children are sick:

Most of the caretakers run to village health team (VHT) members within their village as the first health contacts when their children are sick. The VHTs often handle mild cases of sickness and refer the caretakers to clinics for more complicated cases such as severe diarrhoea.  Some caretakers reported going directly to clinics in cases where the sickness is more serious and is affecting the youngest children.

  • “If it a very young child then they refer you directly to the clinic because young children tend to be complicated at times”, explained a respondent.
Not surprising, some of the respondents said they first treat the children from home before taking them to the clinic. They sometimes have some medicine in their houses thus they give the sick child first aid and when the condition worsens then they take the child to the clinic.
How caretakers interact with their children:
All caretakers revealed interacting with their children of age zero to five years. The main activities spent together with the children include:
  • Chatting—asking questions because child have a lot stories to share and questions to ask
  • Housework—as children are always copying how it is done and want to try it out with the caretakers
  • “I get time and sit my children down and counsel them to be hard working, disciplined and good people. Those who are misbehaving, I cane them”, reported a respondent
  • Having fun through singing and playing together
  • “Every morning I sit them down and counsel them, take them to church, and sing in church so that they are religious”, said a respondent
 
How we can implement the project?
  • "We can make the process interesting all together through drama and plays where by these teachers train the children how to wash hands so that they can act it out for their fellow children. Children always want to try out something that their friends are doing (copy cats)", said the health inspector.
 
Who to go through to implement the project.
  • The LC1s because they always call for meetings to address the people on various issues, the VHTs since they know every person in the community, health workers are also important.
  • Also the school teachers would preach the gospel of hand washing very well among the children. 
 
Health concerns for children zero to five:
  • Malaria, stomach pain, accidents due to too much playing, headaches, these children also doze due to a lot of playing and pretend to be sick.(But these days we give them water to calm down). When these children have malaria, they can even soil their uniforms which is too bad and embarrassing to them.
  • These children suffer from Diarrhoea, malaria, cough and flu and injuries because they play a lot. When these children get sick, we take them to the clinic and are given first aid or even we have paracetamol which we give them and later contact their parents to take them home.
 
Challenges faced by children
  • Most of the children do not want to listen especially the boys in P4 and above thus it’s a challenge to us in grooming these children.
  • Also the girls are generally more hygienic than the boys and the children in the lower classes practice hand washing the more than those in upper classes. Even these children keep reminding themselves like “you are from the toilet, have you washed your hands?” which is a good thing.
  • Most of these children don’t have manners right from home thus it’s hard to groom them from here, remember charity begins at home and the parents say that “omwana mukuwadde” so they abandon their children to the teachers when it comes to upbringing of these children.
  • We as a school lack the proper facilities like tap and soap to facilitate the behavior thus we have to improvise and use the jerrycans that you have seen outside.
  • The toilets are strictly for girls alone wheras the boys use the bush nearby which puts the whole community at a risk of diarrhea outbreak.Availability of hand washing facilities
  • We used to have a tap but now we put water in the buckets and this where these children wash their hands from using a cup to draw the water from the buckets. We have two washing areas i.e at the toilets and at the dining area. But we have a challenge of disinfecting our toilets may be if you could help us do something about it.
  • It was once when an NGO visited the school and gave each child a tablet of Dettol soap but it was long ago s maybe that’s why the hygiene is not good.
  • About the soap, we used to put a tablet of soap but by the end of the day it has disappeared so we resorted to mixing the liquid soap into the water.
 
Framing the loss
  • If we missed out on this project then our children would often fall sick and eventually miss lessons which would affect their studies thus it’s a good idea to start this project. Also we feel bad when these children are ill because we are also parents.
  • We cannot afford to have our children fall sick all the time and miss out on lessons which would be the case if this project is not implemented especially in this school.
  • Success: every teacher wants every child to perform well and excel that is why they feel bad when these children have missed lessons.
  • We would miss a lot if this project was not implemented because it is aimed at improving the health of the children since they are the nation’s foundation.

Updates on discussions with village leader of Kiwologoma village in Kira held on Nov 13:

Perceptions and opinions on the hand washing projecg
  • I am buying the idea of the project because it would improve the general hygiene of the community and children would not fall sick like they do these days.

Health concerns in the community.
  • Malaria is still the most common health problem that disturbs the people in the community, even when the mosquito nets were distributed, people do not sleep in them thus the problem.

Who to go through in the community to reach to the people for the hand washing project:
  • The LC1s  are the right people to go through because they they know all the people in their community
  • Also VHTs can do a great job of taking you around the village, house to house because they know what is going on in people’s households. This can be an option because several times we have called for LC1 meetings and the turn up is low so in case the people don’t show up, they can always take you around the village.

What the community would miss if they do not implement the hand washing project:
  • We would miss out on having a hygienic community since it’s a foundation for a clean and developmental country. Actually in this community, children are usually found very dirty and are not taken care of so this would be a good project not to miss.

 Summary of the key findings from the first set of interviews with key informants today--Nov.11, 2014.

Racheal and Josephine  set out to interview the first local council I chairperson in Balintuma village, Kiwatule parish, Nakawa division, Kampala...here are the highlights:

Perceptions and opinions on hand washing project
  • This is a good project and it is going to be successful because it is not only beneficial to the child but to the rest of the family members.
  • This is because even us the old people find it hard to always wash our hands but if it’s a culture instilled in these children then the rest of the family would be influenced.
  • It is also good to go through the parents/ caregivers to teach these children about the benefits of hand washing so that it reduces the disease burden among these children.
  • In this community, I always see children playing in mad and they are dirty yet they just pick food and eat it without washing their hands and they end up getting sick.
 
The key people to go through for the implementation of the project.
  • Through the village meetings that we always call for and talking to the mothers about the campaign, but if this fails, then we can get these mothers from their association’s e.g saving groups, market groups, where they always meet and talk so the messages can be passed on through these meetings.
  • Also through schools because this is where most of these children spend their time than home and also the parents these days are too busy for their children and cannot attend to them for grooming thus schools would be the best places to teach these children how to wash their hands at critical times.
  • Also these children go home and start sharing to everyone how they taught them how to wash their hands and eventually everyone adopts the culture.
 
How would we get to these people?
 
Framing the loss.
  • If we miss out on this project, then this community will continue to suffer the diseases that disturb the children. 
 
The Big Picture


 

Updated write-up: November 10


Summary:


When children learn early in life and develop the necessary skills, hand washing is more likely to become a habit they will practice for the rest of their lives. Most children develop the ability to wash their hands independently by about three years of age. Before that caretakers need to help them wash their hands (or for babies and young toddlers, caretakers need to do it for them). After age three, children will probably still need a bit of help. Teaching children about hand washing early in life is important. Hand washing prevents the spread of diseases which make children sick. Children are ready to learn about hand washing when they are still very young.

The project will use mass media, interpersonal communication and other forms of social marketing in which people will be reached with messages and the hand washing skills. The project will apply implementation research to identify the perceptions and opinions of parents and caretakers have towards—early child development, ingestion of faecal matter by children, training children on hand washing from early stages of life, perceived role models to achieve this, potential threats to the campaign and partners to work with to roll it out.

The target for the project are parents with children below 5 years, teachers at schools, community leaders, older siblings, children 1 to 5 years, etc.  Since infants and young children are copycats they are more likely to learn from others who are seen washing hands and would act as role models in the adoption of the hand washing skills in the long run.

Children do not always take time to wash their hands and often resist parents and caretakers when they are asked to wash their hands before eating, after using the toilet, after touching animals or upon return from playing with their colleagues. Caretakers will almost certainly need to give them lots of encouragement and reminders. Children do not always enjoy washing their hands, partly because it means time out from more exciting things like playing. So the best strategy is to find ways to make hand washing part of the fun, rather than a distraction from their favorite activities. To address this resistance, the project plans to apply fun filled and innovative approaches that are captivating to the children and are embedded into the usual activities they engage in.

To address the challenges around hand washing facilities, the project will identify and use partnerships with established organizations (CSOs, NGOs, FBOs and government) that are supporting provision of such facilities.  The project will also integrate nutrition and stimulation of children within the hand washing intervention. Finally, in order to sustain the intervention, the project will work through government instituted National Sanitation Working Group (NSWG) and its National Handing Washing Steering Committee (NHWSC), ministries of education and health, district local governments, communities and private sector providing sanitation and hygiene services or goods as partners.
 

Introduction

Early child development (ECD) is a critical life event for all humans yet the recent global evidence indicate it is not receiving appropriate attention. ECD is a product of environmental, biological and social factors, which require addressing in an integral manner. This project is one of the first focused on promoting hand washing culture as means of reducing ingestion of dangerous pathogens by infants and young children.

If successfully implemented at scale, the project will contribute to better ECD outcomes by addressing reducing ingestion of microbial pathogen that increase the risk of stunting and anaemia and their associated adverse effects on brain development.  Using a two pronged approach that focuses on children as the primary target and mothers/other caretakers as secondary audience, the project is overcoming the current WASH programmatic limitation of focusing on mainly mothers and caretakers. Children are the ones who are loaded with dangerous pathogens and are ingesting them during play or during feeding. Hence by focusing on them the project expects to reduce ingestion of the pathogens and to create a generation which takes hand washing as an acceptable behaviour.
 

Challenge being addressed and justification

Despite the role of diarrhoea in childhood malnutrition, current evidence points at environmental enteropathy to have more profound effect on early child development.  Exposure to large quantities of faecal matter due to poor sanitation and hygiene practices causes environmental enteropathy that is responsible for stunting and anaemia that eventually impair ECD[1]. Human and animal feet are often contaminated with loads of faecal matter infected with dangerous microbes and pathogens which are deposited in children’s play and feeding environment. Such faecal matter end up in children’s mouths as they play and ingest soil matter.  Whereas cutting this faecal to mouth route in children is difficult given the hyperactivity of children, training mothers and caretakers on hand washing with soap, safe food preparation, heating, cooling, and storage could reduce the risk of environmental enteropathy. This however is insufficient to overcome the challenge of ingestion of faecal matter by children as it is the children who are directly loaded with faecal matter. It is therefore important that in addition to mothers and other caretakers that WASH interventions directly focused on children for own hand washing at critical times.   
Ngure et al. (2014)6 recommended adoption of new technologies especially child play areas as means of reducing ingestion of dangerous pathogens by children. This is scientifically appropriate but at the moment looks impractical socially, economically and culturally inappropriate in African setting. Yet it is also almost impossible to eliminate faecal matter in children’s play and feeding areas.  Promotion of behaviour change interventions for hand washing by children and their caretakers in addition to traditional household WASH behaviour change together with targeted hand washing, hygienic preparation and storage of complementary foods for children seems the most viable approach to reducing ingestion of these pathogens by children. If the behaviour is instilled into children at an early stage of life, the children are more likely to grow into healthy and productive adults with a culture of washing their hands. A vicious cycle of hand washing could easily be created as result of such intervention if it is promoted at scale. Not only will this save lots of resources currently spent on enticing adults who did not grow up washing their hands, but will also create population of adults who grow to their full potential. In addition, it is important to explore the social, economic and cultural acceptability of the concept of safe child play spaces in low income households.

Obtaining perceptions and opinions of the mothers and other caretakers regarding child centred WASH interventions and on how to reduce environmental enteropathy and diarrhoea would be important in designing the hand washing intervention to reduce the interaction between faecal-oral vectors of the child’s hands and the hand-to-mouth activity.

Reference:
[1] Francis M. Ngure,Brianna M. Reid, Jean H. Humphrey,Mduduzi N. Mbuya, Gretel Pelto, and Rebecca J. Stoltzfus.WASH, environmental enteropathy, nutrition and ECD. Ann. N.Y. Acad. Sci. ISSN 0077-8923 pg.118-128
 

Goal:

  • To contribute to the improved early child development outcomes through reduction of morbidity and undernutrition among children below 5 years due to ingestion of faecal matter.
 

Objectives:

  • Assess the perceptions and opinions of parents, grandmothers, teachers, health and community service providers and other community representatives on hand washing and prevention of ingestion of faecal matter by children under 5 years in Central Uganda
  • To promote the culture of hand washing among children below 5 years using mass media, interpersonal communication and other forms of social marketing in Central Uganda
  • To establish and strengthen linkages and partnerships  with existing government, NGO, CSO and community interventions to increase the accessibility of hand washing facilities within Central Uganda
  • To establish cost effectiveness and acceptability of hand washing among children and mothers/caretakers as form of protecting children against ingestion of dangerous microbial pathogens and associated adverse ECD outcomes in Central Uganda.
 

Sustaining the intervention

  • The continued commitment of teachers is essential to the continuation of washing hands encouragement and training of the children also for the parents to be committed in guiding and supervision of these children as the adopt to the behavior.
  • As this behavior is targeting the children when they are young we hope that when they grow older they will teach their young fellows the same practice.
  • Involvement of the private sector such as companies providing detergents is likely to keep the intervention on going even after the end of this project.
  • By integrating the current proposed intervention into ongoing government, development partner, CSO, NGO and community WASH, nutrition and ECD intervention is also likely to enhance its sustainability.
  • Reduced provision of handouts such as detergents and encouraging communities to purchase the items at subsidized rates or to make own items would enhance its sustainability.



Through this project we aim at instilling the culture of washing hands among children as early as  one year when they start understanding so that the habit grows in them as they grow older. We have learnt that it is difficult for grown-ups to take up the behaviour of washing their hands at critical times such as after using the toilet, before eating food, after touching animals, etc.

So with this idea we hope to encourage caretakers to actively train their infants and young childen to always keep their hands clean by washing them with water at critical times! We know that diarrhoeal diseases and environmental enteropathy (a subclinical condition caused by constant fecal-oral contamination and resulting in blunting of intestinal villi and intestinal inflammation) are the most threatening challenges to good growth and development of children zero to five. With increased evidence of how poor hygienic behaviours lead to diarrhoeal diseases and environmental enteropathy, many programs are promoting hand washing among women of reproductive age and adults in order to reduce the burden of these diseases.

However, children are often not looked at when promoting these behaviours yet they are the ones affect and will grow into parents to take care of children. Hence, it is important to encourage adults especially mothers to instill hand washing behaviours into their children in order to kick out diarrhoeal diseases and enteropathy (which is linked with increased stunting in children). Children learn most of the behaviours in early stages of life and mostly from their mothers and caretakers. This project would accelerate the process of creating lasting hand washing behaviour in children and adults since masses would be reached.
 
Approach:
The campaign 'My clean little hands, my health insurance for Life' will use mass media, interpersonal communication and other forms of social marketing that accepted by Ugandan communities. We will apply implementation research to identify the perceptions parents and caretakers have towards training children on hand washing from early stages of life, perceived role models to achieve this, potential threats to the campaign and partners to work with to roll it out.

The campaign will apply fun filled and innovative approaches that are captivating to the children and the caretakers alike. Children often resist parents when they are asked to wash their hands before eating, after using the toilet, after touching animals such as dogs, calves or cats or upon return from playing with their colleagues. Parents also often give up and let the children take the path they wish. Encouraging children to wash their little hands is indeed an insurance for life and is worth all the resources as hand washing is the best way to preventing germs from spreading and keeping children from growing to their full potential or at worst losing their lives. Indeed hand washing is the first line of defence that every smart parent should be proud to inculculate into their children.
Because of the potential resistance from children, we will use strategies that are easy to take up and are doable by all caretakers and children. Children love to have fun and it is this fun that often exposes them to germs and even makes parents prevent them from playing. Our project will thus use fun to promote this intervention.
Why this project will succeed?
We are convinced this project will succeed because it affects every loving and smart caretaker who wants to see their children grow and thrive into the greatest adults. There are already lots of programs focused on addressing diarrhoeal diseases around the world and in Uganda particularly. We will not be starting from scatch and will link up with such initiatives to promote this campaign.
 
Questions for the community
Areas for research through focus group discussions
  • Urban community
  • Rural community
  • School
Questions for the parents/caretakers.
  • What hopes and dreams do you have for your children?
  • How do you interact with your child
  • Who is your role model and for your child?
  • What difference would eliminating diarrhea and enteropathy have in your life?
  • How would you feel if you were able to eliminate diarrhea?
  • What do your children spend doing most of the time?
  • Where do your children spend most of their time??
  • Who do you turn to for help when your child has a health problem?
For the teachers
  • How do you feel when the children are absent due to illnesses?
  • What help do you give to the children when they are ill?
  • What are those common health issues that disturb the children?
  • How would it make a difference in your life if you contributed in reducing these health problems among the children?
  • How would you feel if all the children were able to attend school?
  • As a school, what measures do you have to ensure hygiene of the children
  • Do you have a washing area? 

 

Who will benefit from this idea and where are they located?

All parents and caretakers of children zero to five, and children of this age group in rural and urban parts of Uganda would benefit from this project. this is targeting the children because when the child is still young their minds are fresh and can master what they are told by the caretakers so if the habit of washing hands is instilled in these young children they grow up practicing the behavior.

How could you test this idea in a quick and low-cost way right now?

We would first hold interviews and focus group discussions with parents and caretakers of children zero to five in a selected community in Uganda in order to understand their perceptions and opinions on how to inculcate hand washing into children. This will help us define a strategy to use to implement the campaign. We will then work with role models and media houses to run the campaign in the selected community in order to enhance the practice of parents to train their children to always clean their little hands. Finally, we will actively monitor the campaign to check progress, learn and adapt as means of strategizing for scaling up the intervention.

What kind of help would you need to make your idea real?

We are mainly looking for partnerships to help us plan, implement and monitor the campaign.

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.

46 comments

Join the conversation:

Comment
Spam
Photo of Tinotenda Dube
Team

This is a very applicable idea. However, where is it that you plan on implementing the proposal. I ask because, there are areas in this world in which clean water is unfortunately still a desire instead of a basic requirement. Hygiene is very important, particularly in developing children, given the correct direction, I don't see why this proposal wouldn't excel

Spam
Photo of International Youth Empowerment Network
Team

Thank you Dube for the feedback. We plan to run the campaign in Uganda.

Spam
Photo of Shakira Twaha
Team

This is a great idea when implemented well it will create wonders

Spam
Photo of International Youth Empowerment Network
Team

Thank you Shakira

Spam
Photo of An Old Friend
Team

Shakira, any ideas of how it would be implemented well? Thanks!

Spam
Photo of Uve Kindia
Team

Maybe a structual formatted guide line book. Rules to be followed on the way it should be excitcuted for better maximised results

Spam
Photo of An Old Friend
Team

Racheal and Josephine updated the proposal for this idea based on the feedback we received from Dr Francis Ngure, who has been doing work on nutrition, ECD and enteropathy for the World Bank.

Spam
Photo of An Old Friend
Team

Hi Racheal!

You may consider teaming up with Bettina and see how you can make us of the upcoming inaugural Kampala football festival slated for December 18: http://www.ntv.co.ug/news/sports/06/nov/2014/kampala-football-festival-slated-december#sthash.xQmvwPr8.dpbs to prototype this idea with children and caretakers.

Spam
Photo of International Youth Empowerment Network
Team

We were surprised that in Sebowa zone some members of the focus group would get worried that their children are not growing well if they did not get diarrohoea. We believe this is a misconception but would be glad to hear what the community thinks:

"If the child is growing up, there are some stages they have to go through e.g. development of teeth, learning how to sit, stand and it is always proper for the child to have diarrhoea in these stages. So if this condition (diarrhoea) was to be eliminated completely then it would be worrying a bit", explained a respondent.

Spam
Photo of Natasha Abadilla
Team

Hi, thank you for sharing your idea! I work with the same NGO as Anne Gildea (whose comment is two comments below mine), and one of my main responsibilities is overseeing the success of our WASH (Water, Sanitation, and Hygiene) Program, in which as Anne described, we have put clean drinking water and hand washing stations in schools, covering our entire sub-county.

One idea that I have for your project would be to use simple, easy-to-learn songs and dances that will not only teach children proper hand washing techniques, but also cause children to remember to wash their hands and that washing hands can be fun. One of my organization's past fellows created a "hand washing song," which is accompanied by hand motions, that our health educator often teaches children when delivering hygiene education to them. I have found that children remember this simple song for years, and that it has often reminded them that hand washing is important. Our "song" features "nonsense words" so that it is translatable across cultures and languages, and these "words" also introduce a certain amount of silliness into the song that young children enjoy.

Overall, I love that much thought and research was put into your idea!

If you have the time, I'd love to hear your comments on my team's idea, under the Parenting Information mission: Maternal and Under 5 Health and Education Clinics. (https://openideo.com/challenge/zero-to-five/ideas/maternal-and-under-5-health-and-education-clinics) Any ideas you may have to help us improve our idea would be greatly appreciated. Thank you!

Spam
Photo of OpenIDEO
Team

Congrats on this post being today's Featured Contribution!

Spam
Photo of International Youth Empowerment Network
Team

Thank you OpenIDEO team for featuring our idea!

Spam
Photo of Anne Riitho
Team

Hello, thank you for sharing! It would be great to see this project put into action. We currently have installed hand washing tanks and done health education lectures on hand hygiene at 180 area schools in Meru, Kenya. Behavior change is so difficult as the students get older. In our experience, one of the challenges we face is the availability of soap, both in schools and homes. Have you considered also training caregivers on the process of making soap? It could be a useful addition to ensure they are using soap to wash their hands.

Spam
Photo of International Youth Empowerment Network
Team

Hello Anne! Thank you for your feedback. We seem to hear you confirm how important it is to train children about hand washing while still young!

Well, the idea of training caregivers on the process of hand washing is great. It could be used to leverage income generating activities that women are already engaged in. This could also entice them to keep meeting in groups to discussion the soap making enterprise in addition to promoting hand washing. Anne, are you already engaged in training caretakers on making soap?

Spam
Photo of Anne Riitho
Team

We are not currently engaged, but have a workplan in place to begin training teachers how to make soap starting in January. We work through the school systems, and therefore we are training teachers to work with health clubs. They can then decide how to leverage the soap making skills to provide soap for their HopeCore provided handwashing stations, or if they would like to make enough to sell it as an income generating project to the community.

Also, if you taught the care givers and they were able to earn a bit of money as well, then perhaps that would give them the income to help provide for the basics of their children as well. I look forward to seeing how your idea develops! Keep up the great work.

Spam
Photo of International Youth Empowerment Network
Team

Thank you, Anne! Let's explore this viability of the enterprise with the caretakers and then look around for entrepreneurs in soap making.

Spam
Photo of Dave Zinsman
Team

I love this idea. Where are you at with the campaign? I'd love to help!

Spam
Photo of International Youth Empowerment Network
Team

Hi Dave. Happy to have you on the team. We just pull the idea up today. So we are just at the idea phase. Welcome to the team!

Spam
Photo of wekesa zab
Team

Great - kindly check this out and find out how you might collaborate and share lessons learned during implementation - https://catapultdesign.org/project/ipa/

Spam
Photo of An Old Friend
Team

Dave, how might you be of help to the team?

Spam
Photo of Dave Zinsman
Team

Hey all, sorry I went dark for a bit there. I'd love to help out lending a design hand for your implementations. It looks like the proposed solution is:

"use mass media, interpersonal communication and other forms of social marketing to build a culture of hand washing."

Throw up a couple ideas/rough sketches of how we can go about doing that, and I'm happy to help you build it!

Spam
Photo of International Youth Empowerment Network
Team

Thank you Dave. We are excited to have you on the team. We have shared draft comprehensive write up on gmail and have also shared the same document on google drive. Let's refine it. Thanks!

Spam
Photo of Chioma Ume
Team

This collaboration is exciting! Visuals are always a great starting point for bringing ideas to life. Looking forward to seeing what grows out of this!

Spam
Photo of Richard Zulu
Team

Great engagement International Youth Network. Like Chioma said, leverage a lot of visuals henceforth to share the idea. Great idea indeed.

Spam
Photo of International Youth Empowerment Network
Team

"If we missed out on this project then our children would often fall sick and eventually miss lessons which would affect their studies thus it’s a good idea to start this project. Also we feel bad when these children are ill because we are also parents", teacher frames the loss in one of the interviews.

Spam
Photo of Jinal Sanghavi
Team

Hi, do check out this write-up on the successful hand washing campaign consudted by Hindustan Unilever in India. You may find some very relevant ideas on how and when to message: http://www.hul.co.in/mediacentre/newsandfeatures/2013/Lifebuoy-spreads-the-handwashing-message-at-the-Maha-Kumbh-Mela.aspx

Spam
Photo of International Youth Empowerment Network
Team

Hi Jinal, this information is great. Thanks for sharing, we should consider contacting Uniliver Uganda and seeing how we can partner with them here.

Spam
Photo of International Youth Empowerment Network
Team

Hi Community, Racheal and Josephine set out to interview the first local council I chairperson in Balintuma village, Kiwatule parish, Nakawa division, Kampala...

Spam
Photo of International Youth Empowerment Network
Team

Dave, you have gone silent! We miss your contribution!

Spam
Photo of International Youth Empowerment Network
Team

We have attached the draft proposal in the idea write up. Please check it out and help with your feedback.

Thanks!

Spam
Photo of Duncan Maru
Team

Great start! My biggest concern is that I fear education/behavior change initiatives tend to be ineffective without addressing core service delivery gaps. In this case, its not access to both purified water and to a higher volume of water. Indeed, the conquest of cholera and others in many societies was less about hygienic behavior change and more about water & sanitation infrastructure. An interesting reference from Mumbai written by a colleague of mine is here:

http://www.biomedcentral.com/1471-2458/13/173

I am skeptical that a strictly behavior change intervention in the absence of public sector improvements in water access will be able to move the needle on what you ultimately want-- namely, a decrease incidence, morbidity, and mortality from childhood diarrheal diseases.

Perhaps combining this social media intervention with grassroots advocacy to improve water services? Can they map out water access and purity and translate that into one of the most important behavior changes in public health-- that of governments to step up and provide basic services to their most vulnerable citizens.

Spam
Photo of wekesa zab
Team

Your post - interesting .. Duncan..

Hey Alex -

http://www.tippytap.org/

Check out this - "Thus, the Tippy Tap has become an integral part of not only the Yatra but also the concurrently running WASH in Schools Program that aims to train 30,000 children and 200 teachers in good sanitation and hygiene behavior across India."

Spam
Photo of International Youth Empowerment Network
Team

Thanks Duncan! Yes, the fears you raise are real. In Racheal's comprehensive write up of the proposal she has an objective of identifying existing government, NGO, UN, district and community initiatives engaged in provision of WASH hardware to address the gap. Hopefully, this will help address the gap especially in rural areas.

However, we should also be aware that even in urban areas of Uganda where there is plenty of clean and safe water, hand washing with soap or just want is low (30%). This tells us there is more to do regarding creating a culture of hand washing.

Thanks!

Spam
Photo of International Youth Empowerment Network
Team

Thanks Wekesa for sharing the information. In the current write up, we are looking beyond schools and teachers. We want to have teachers, pupils, pre-schoolers, parents, community leaders, elders and health service providers actively engaged in promoting the culture of hand washing while addressing related hard ware requirements.

Spam
Photo of Chioma Ume
Team

Great thread of comments everyone! To Duncan's point, have you already considered specific WASH interventions that are generating some success in Uganda? It might be interesting to incorporate some of what they've learned in the development of your idea - and to begin to think about how your idea can collaborate, build upon or fit into an existing landscape that will help ensure the outcomes you seek. Looking forward to learning more about this!

Spam
Photo of International Youth Empowerment Network
Team

Hi Chioma! We have taken care of that in the updated proposal. The plan is to
integrating into the current proposed intervention into ongoing government, development partner, CSO, NGO and community WASH, nutrition and ECD interventions.

See the attached draft proposal we are refining with Francis Ngure!

Spam
Photo of Raymund Sison
Team

"Our project will thus use fun to promote this intervention." -- I like that idea!

I'm a computer science professor from a developing country, where I'm also involved in a few small ministries that directly or indirectly involve kids in low-income communities. I could form student groups to develop mobile games to motivate kids in low-income communities to wash their hands. If the target beneficiaries are kids aged 1-5, then instead of playing the games themselves, they could "play" the games "vicariously" through an adult, who could project the game on a screen, or simply act out the game, while she is playing it "on behalf of the kids." Playing the game on behalf of the kids means that it's the kids who will tell her what specific moves to make in the game. The game could have a graphical user interface, or could simply be text- (and sound-)based. (Of course the assumption here is that there are Tippy Tap-like stations that are available in or outside the play area. ) What do you think of this way of "using fun to promote [the] intervention"?

Spam
Photo of International Youth Empowerment Network
Team

Hello Sison!

Thank you for taking time to review our idea. This energizes us more!

We welcome your idea and would be glad to have it increase the fun of creating a culture of hand washing among children. We are ready to go with.

We will have to test it with the children and caretakers here. When do you think we can have something to test?

Thanks a lot~!

Spam
Photo of Stan Jarzabek
Team

Yes, Raymund, I believe messages delivered in such a way will stick with people; I would like to try our apps in our project on monitoring child nutrition, Roth and development
Stan

Spam
Photo of International Youth Empowerment Network
Team

See the attached draft user experience map that we are working on!

Spam
Photo of Stan Jarzabek
Team

thank you, happy to join your team and looking forward to working together
Stan

Spam
Photo of Stan Jarzabek
Team

Wonderful idea, Racheal! Simple, impactful, realistic. Once not washing hands by hospital personnel was identified as a key contributor to spreading diseases among hospital patients. Behavioral change approaches were applied to address the problem with great results. Your project may have great impact and I would love to contribute what I can, may be in the area of educational and rewarding part of it. Your start point to understand how people in the community feel about it is a promise you will succeed.

Some ideas that come to mind:
-- use positive deviance analysis to find out kids that wash their hands and see what motivates them to do so; may be same things can work for others in teh community
-- apply behavioral change methods (use story telling, motivating examples rather than preaching about benefits of washing hands); great book is "Influencer: The New Science of Leading Change", interesting to read, informative, many examples, may be useful to you
-- use some kind of reward system, get ideas from gamification; may be insurance companies will be willing to give discounts for health insurance to those who provide evidence of knowing and applying hand washing protocols
-- may be some kind of educational and reporting systems (via mobile phones?) can be used to reach people and get feedbacks

wishing you best luck with the project
Stan

Spam
Photo of An Old Friend
Team

Interesting to see a man taking the lead in training his son to grow up as responsible person who always washes his hands! Racheal, when do we start prototyping this idea? Thanks

Spam
Photo of International Youth Empowerment Network
Team

Thank you Alex, we are to start as soon as this weekend.

Spam
Photo of Meena Kadri
Team

We look forward to our next steps on this around holding foci groups to learn more from communities themselves. Do post updates as your idea evolves!

Spam
Photo of International Youth Empowerment Network
Team

Thank you Meena,