Promoting handwashing

Unilever is working with governments, health agencies and non-profit groups to promote the importance and practice of handwashing with soap at the right times during the day.

The importance of handwashing

Studies show that washing hands with soap is one of the most effective and inexpensive ways to prevent diseases: it can cut deaths from diarrhoea by almost half and from acute respiratory infections by a quarter.

USLP logoOur Lifebuoy soap brand leads our handwashing campaigns. On sale in around 45 countries across Asia, Africa and Latin America, Lifebuoy has developed a clear social mission. By 2015, it aims to change the hygiene behaviour of 1 billion consumers across Asia, Africa and Latin America by promoting the benefits of handwashing with soap at key times.

A framework for change

Understanding what triggers consumers to change their daily habits lies at the heart of making sustainable improvements to hygiene.

Our Lifebuoy brand has been at the forefront of monitoring and evaluating handwashing behaviour change programmes. The experience gained through its programmes in Asia and Africa has enabled Lifebuoy to develop a bespoke four-step process to encouraging consumer behaviour change:

  1. Awareness: the first step is to ensure that consumers understand why the practice of washing hands at key moments is so important.
  2. Commitment: consumers then need to make a commitment to changing their habits.
  3. Reinforcement: if consumers can practise this new habit for at least 21 days the likelihood of it becoming a permanent habit is much higher.
  4. Reward: consumers need to feel that they are being recognised and rewarded for continuing to follow good hygiene habits.

Reaching 1 billion people

In 2010 Lifebuoy launched the Delta Strike Mass Activation Programme (DSMAP), a new mass behaviour-change programme based on its four-step process.

This programme builds on the success of Lifebuoy’s hygiene promotion activities that have been run in countries such as India, Bangladesh, Sri Lanka, Pakistan, Indonesia, Vietnam and South Africa. Lifebuoy has been running the Swasthya Chetna (‘Health Awakening’) programme since 2002. As India’s largest rural education initiative, the Swasthya Chetna programme has reached more than 120 million people since it began, raising awareness of the importance of handwashing with soap through live demonstrations and workshops.

Pair of hands held under ultra-violet lightOne of the key elements of Lifebuoy’s hygiene education approach is the ‘glowgerm’ demonstration. This counters the common misconception that ‘visibly clean’ is ‘hygienically clean’. When held under ultra-violet light, glowgerm powder glows on the dirt left behind on hands washed only with water, providing a powerful emotional reminder that handwashing with soap provides greater protection against germs than washing with water alone.

Our new DSMAP programme uses different approaches across each of the four steps:

  • mass media (to drive awareness and benefits)
  • school programmes (to drive active behaviour change)
  • mother’s programmes (to allow mothers to partner with children in the programme and involve doctors/medical staff in the awareness of the five daily occasions when people should wash their hands)
  • packaging (to increase involvement in the programme).

Vietnam was the first country to launch the programme. The campaign aims to build awareness of the five important times in the day when people should wash their hands with soap:

  • when bathing
  • before breakfast
  • before lunch
  • before dinner and
  • after going to the toilet.

A television and poster advertising campaign featuring the popular actress, Hong Van, was used at the start of the programme to build awareness. Lifebuoy also launched a schools programme in partnership with the Vietnamese Ministry of Education and Training and the Ministry of Health. Both teachers and parents are involved in ensuring that children wash their hands with soap. Parents are encouraged to supervise and track their children’s commitment at home. Using a timetable as a tracking device, children are encouraged to fill in the timetable either with a sticker or a parent’s signature every time they have washed their hands with soap. Completed timetables are then handed in to teachers who reward the children with small gifts.

The programme was also launched in Pakistan, building on the successful hygiene promotion programme, Mahfooz (‘Rural Neighbourhoods’) Pakistan, that Lifebuoy has been running in the country since 2005. The campaign was launched with a television commercial featuring cricketer Wasim Akram. A schools programme has been established and special limited edition Lifebuoy soap packaging introduced featuring Wasim Akram and handwashing messages. Partnerships have been built with NGOs ITA (Idara-e-Taleem-o-Agahi), Friendship International and the UN World Food Programme to help ensure that the programme reaches as many people as possible in the most effective way.

The Delta Strike programme will be rolled out more widely from 2011 onwards.

Evaluating the effectiveness of our approach

Unilever’s distinctive approach is to put the monitoring and evaluation of behaviour change at the heart of our programmes. We have greatly advanced our understanding through our partnerships and innovative measurement techniques.

  • Smart sensor technology

Soap bar chartOur smart sensor technology is now widely regarded as the best way of measuring handwashing behaviour. By placing a smart sensor inside a soap bar researchers can gather accurate data unobtrusively during handwashing trials and thereby monitor the extent to which different types of awareness-raising initiatives actually lead to changes in behaviour in people’s homes.

  • Clinical trials prove effectiveness in India

To assess whether using soap at the right times could reduce the incidence of sickness in families, Lifebuoy conducted a clinical trial in Mumbai, India over 2007–2008 involving 2 000 families. Half the families were supplied with soap along with regular education about the importance of washing hands with soap at five key occasions during the day. The other half continued with their normal hygiene practice, acting as a control group.

The trial revealed that, among those that had received hygiene education, the use of soap increased by as much as ten times and led to a 25% reduction in the number of incidences of diarrhoea among children aged five. The trial also showed a 19% reduction in acute respiratory infections and a 46% reduction in eye infections.

  • Tracking our success in Indonesia

A study of our Lifebuoy Berbagi Sehat (‘Sharing Health’) programme in Indonesia, which is aimed at mothers and children, showed that 84% of those who had been involved with the Berbagi Sehat programme subsequently washed their hands with soap after using the toilet, compared with 58% in the control group (of people who had not participated in the programme).

Global Handwashing Day

Global handwashing logo Launched in 2008, Global Handwashing Day is an annual event backed by the Public-Private Partnership for Handwashing with Soap, of which Unilever is a founding partner.

In 2010, more than 80 countries celebrated Global Handwashing Day. Lifebuoy co-ordinated efforts with more than 50 organisations in 19 countries. Millions of school children took part in awareness-raising activities and were encouraged to make handwashing pledges. Examples include:

  • in Indonesia over 3 million school children participated in school competitions
  • in Kenya, 19 352 people gathered in a school to wash their hands with soap, and secured the Guinness World Record for the most people washing their hands at one time in a single location
  • in Bangladesh, a third Guinness World Record attempt was made with over 86 000 school children across the country simultaneously washing their hands
  • in South Africa, well-known singer Yvonne Chakka Chakka performed a song especially created for Global Handwashing Day, called “Bumbanani” (Let’s Unite Against Germs).

And for the first time, Lifebuoy helped to spread the Global Handwashing Day message more widely using Facebook and Twitter.

Sharing our expertise through In Safe Hands

For many years, through our In Safe Hands programme, Unilever has been helping to build expertise in the public sector on effective behaviour change campaigns. Continuing these efforts, in November 2010, a group of trade organisation and public sector representatives from the Ministries of Health and Education in Brazil, Kenya, and Uganda joined Lifebuoy employees on a study tour in Vietnam which aimed to inspire the creation of public-private partnerships.

The tour provided first-hand experience of rural and urban handwashing programmes in action, looking at low-cost handwashing devices and seeing public-private partnerships at work. As well as sharing knowledge and best practice, the study tour also provided advice for the representatives on developing effective public-private partnership and action plans for Brazil, Kenya and Uganda.

Contributing to disaster relief efforts

Following the floods in Pakistan in 2010, there was an increased risk of catching life-threatening water-borne diseases such as diarrhoea. Lifebuoy provided 68 000 households with 118 000 bars of soap and Unilever gave donations through Oxfam, Save the Children and Population Services International.

Haiti experienced a serious cholera outbreak in October 2010. Working with the Unilever team in the Dominican Republic, the Lifebuoy team helped to design and distribute information materials to raise awareness of the importance of handwashing with soap during such an outbreak, together with over 750 000 bars of Lifebuoy soap.

Improving survival chances for newborn babies

Every year an estimated 4 million newborn babies die in the first month of their lives. 86% of these deaths are due to a combination of infections, prematurity and complications during labour.

In countries where newborn mortality is high, handwashing with soap is not standard practice among mothers and health workers before the birth and when handling newborn babies. A community study in rural Nepal found that handwashing with soap can reduce newborn deaths by up to 44%.

The United States Agency for International Development (USAID) and its Maternal and Child Health Integrated Program (MCHIP) have joined forces with Lifebuoy to raise the profile of handwashing for newborn survival. We will work together to design a handwashing behaviour-change programme to help new mothers and health workers adopt the practice of handwashing with soap as an ingrained habit at critical times. This programme will initially run in Bangladesh, Kenya, Nigeria, Indonesia and India.

Linking hygiene & sanitation

Water and Sanitation for the Urban Poor (WSUP) works to improve water and sanitation services in poor urban areas. To be effective, improvements in sanitation need to be accompanied by improved hygiene practices.

Lifebuoy has been working with WSUP to expand the impact of its programmes. A pilot project in Dhaka in Bangladesh and Nairobi in Kenya has seen a joint programme, based on Lifebuoy’s Delta Strike Mass Activation Programme, rolled out over the course of a year with a $110,000 investment by WSUP and grant funding from AusAID. The pilot will run until June 2011 and will expose 300,000 people to Lifebuoy’s messages for washing hands at five critical times of the a day. We estimate that behaviour change will occur in 17-20% of those reached. With each person securing commitments from 10 additional friends or family members, we hope that our communications will reach up to 3 million people.

For WSUP, this is cost-effective way of harnessing private sector expertise to achieve significant impact at scale – with relatively low levels of investment. A key part of this is the training of health workers, community leaders and school teachers in methods that can be replicated and reinforced over time, thereby widening the impact of the programme.

Domestos promotes the need for better sanitation

Around 2.5 billion people across the world do not have access to proper sanitation, with serious implications for health and hygiene. For example, in a typical hospital in sub-Saharan Africa, more than half the patients will be suffering from faecal-related disease – but most of them would not be there if they had clean toilets and clean water and soap to wash their hands.

Domestos, our household care brand, has sponsored World Toilet Day since 2009 to raise awareness of toilet sanitation and help improve conditions worldwide. In 2010 the brand went digital in its support of the event by creating a web application called Flush Tracker. Users in the UK, Ireland, Poland and South Africa could enter the time and location of a flush on the website, and an interactive map displayed the journey of their flush to local sewage works, with email alerts also showing progress. The email alerts drew attention to the disparity between good and bad sanitation and the associated health risks. The campaign rapidly went viral, with users networking through Facebook, Twitter and other social media. Radio and print content was also generated and users from 150 countries visited the Flush Tracker website.

Unilever is also working on a domestic sanitation project with Water & Sanitation for the Urban Poor. See Working with Others for more.