† Independently assured by PwC - see Independent assurance
Since 2010, we have made strong progress, developing models which more than halve the cost. We have expanded the programme to 16 countries in 2012 and have reached five times as many people as we did in 2010.
Our most significant expansion is in Africa. During 2012 Lifebuoy launched its full 21 day Lifesaver handwashing programme in eight new countries: Egypt, Ghana, Nigeria, South Sudan, Uganda, Zambia, South Africa and Zimbabwe. We now have programmes running in nine African countries, reaching more than 11 million people in 2012, compared to 400,000 over 2010–11. This has contributed to Lifebuoy’s continued double-digit business growth in 2012.
Our behaviour change programmes are now running in 16 countries, reaching six of the top ten countries most affected by child mortality. The multi-country programme, which was launched in 2010, uses a number of channels to deliver handwashing interventions:
- direct contact with children through school programmes and with mothers through women’s groups and health clinics
- rural outreach programmes which take handwashing messages to remote villages
- mass media, such as TV, print and radio advertisements, to raise awareness of the importance of washing hands with soap at key occasions
Our expanded programme builds on the success of Lifebuoy’s hygiene promotion activities that have run over many years. These activities have reached millions of people and raised awareness of the importance of handwashing with soap through live demonstrations and workshops.
Moving faster to widespread implementation
The major challenge we face is scaling up our handwashing programmes cost- effectively. Partnerships with NGOs and government are critical – by tapping into existing on-ground networks and expertise we can reduce costs and reach more people. In Africa, Unilever Foundation partner PSI (Population Services International) and the Millennium Villages Project are helping us to adapt our programmes to different contexts. In India we are working with the government and Foundation partner UNICEF to promote handwashing in Madhya Pradesh and in Africa and South Asia, with Water & Sanitation for the Urban Poor. These partnerships are also building local capabilities to sustain the programmes for the long term.
We continue to evaluate impact. In Indonesia we conducted a quantitative study with TNS, a market research company, to assess impact when the programme is run at scale. We found that handwashing with soap at key occasions increased significantly after the school hygiene promotion programme. Soap use increased from 53% to 75%. This increase was sustained more than six months after the programme ended.
Working with schools in Indonesia
In Indonesia, we have pioneered a cost-effective and scalable model for rolling out handwashing education programmes in schools. This new model is based on a partnership approach between Lifebuoy, the Indonesian government and NGOs.
Lifebuoy trains teachers to deliver the handwashing behaviour change programme. We also provide the materials and toolkits they need. Each teacher then cascades the programme to a further three schools, through a ‘train the trainer’ model to create a multiplier effect. Lifebuoy enlisted the help of NGO partners to provide monitoring and evaluation.
This partnership approach, involving the government, schools, teachers and NGOs, has enabled Lifebuoy to reduce the overall cost of the programme, thereby increasing our ability to take it to scale.
Lifebuoy handwashing programmes in Indonesia reached over 700,000 children during 2012. In addition we reached 4.2 million mothers through our mothers programme.
We are now looking to extend the approach to other countries.
Working with WSUP
Lifebuoy has also been working with Water & Sanitation for the Urban Poor (WSUP) to expand the impact of its handwashing programmes through promotional campaigns in Bangladesh and Kenya since 2010. The projects have reached almost 300,000 people (205,000 in Bangladesh and 80,300 in Kenya) with Lifebuoy’s handwashing messages.
WSUP works to improve water and sanitation services to low-income urban consumers. To be effective, improvements in sanitation need to be accompanied by improved hygiene practices.
WSUP and Lifebuoy jointly launched school programmes to bring about changes in the handwashing habits of children and their families. This approach also focused on training school teachers in a methodology that can be replicated and reinforced over time, thereby widening its impact and sustainability.
For WSUP, supporting Lifebuoy’s handwashing behaviour change programmes is a cost-effective way of harnessing private sector expertise to achieve significant impact at scale.
Working with PSI
PSI is one of five global partners that we work with through the Unilever Foundation. In 2012 we worked together on the Lifebuoy handwashing programme in schools in Kenya and Zimbabwe. The projects have changed the handwashing behaviour of an estimated 1.3 million consumers by promoting the benefits of handwashing with soap at key times.
Partnership with Millennium Villages
Some communities can be difficult and costly for Lifebuoy to reach by itself. We are collaborating with the Millennium Villages Project to promote handwashing with soap in rural communities across Africa.
The project will enable us to adapt our current handwashing programme and advocacy to this setting, reaching 475,000 people across ten countries by 2015. Our aim is to work together to develop scalable, cost-effective water, sanitation and hygiene interventions which can then be rolled out at national level and to new countries, improving health through better hygiene.
Khushiyon Ki Doli (KKD) (‘Caravan of happiness’) is a multi-brand rural outreach programme run by Hindustan Unilever in India. A team of promoters equipped with a battery-powered TV set and other demonstrations and games travels deep into rural communities that typically do not have access to mainstream media. As one of the participating brands, Lifebuoy runs a tailor-made educational video that explains the importance of handwashing at key occasions. It is complemented by a live ‘glo-germ’ demonstration which shows that visibly clean hands are not necessarily hygienically clean.
Through KKD, Lifebuoy has reached 38 million people in rural India over 2010 to 2012, and plans to continue its activity through to 2015
In Indian states such as Uttar Pradesh, where KKD reached a high proportion of villages, Lifebuoy has seen an average growth in soap consumption of 11%. This is very promising in terms of business return. It also demonstrates the potential for this type of intervention to change handwashing behaviour in rural areas.
KKD builds on the success of Lifebuoy’s hygiene promotion activities that have been run over many years in countries such as India, Bangladesh, Sri Lanka, Pakistan, Indonesia and Vietnam. For example, Lifebuoy co-ordinated the Swasthya Chetna (‘Health Awakening’) programme between 2002 and 2009. As India’s largest rural education initiative, the Swasthya Chetna programme reached more than 120 million people, raising awareness of the importance of handwashing with soap through live demonstrations and workshops.
A lower-cost model for our schools programmes
Lifebuoy has ambitious plans to scale up the reach of its school hygiene promotion programmes in Africa. However, in some countries the brand has been launched or re-introduced only recently and is still a relatively small brand. A multi-brand programme is more cost-efficient and is an opportunity to connect people to more of our brands that have a social impact.
Our Central African business and Lifebuoy have piloted a programme with our Close Up toothpaste and Blue Band margarine brands in Nigeria and an external partner, D.lite, which produces solar lanterns to enable children to do homework after dark.
The 21-day programme uses multiple classroom contacts to help children practise new behaviours: handwashing with soap, brushing teeth day and night, and eating well. We have been able to reduce our cost per contact significantly by sharing costs across brands.
The programme has huge potential for roll-out in other countries in Africa. Schools, governments and NGOs support this approach as, by promoting a number of healthy behaviours together, it has the potential to deliver significant health impact at lower cost.
Improving survival chances for newborn babies
The first 28 days of life is the period when children are most vulnerable to disease and infant mortality is highest. Every year, an estimated 3.6 million newborn babies die in the first month of their lives. Simple low-cost interventions such as handwashing with soap can reduce this figure by up to 44%.
In Indonesia we have developed a new partnership with USAID and the Maternal and Child Health Integrated Program to reach new mothers and birth attendants with hygiene education.
A challenging target
Achieving our targets to reach such significant numbers of people with hygiene messages and safe drinking water was always going to be challenging. While we have made progress, we recognise there is a considerable gap to fill to achieve our goal.
This is particularly true for Lifebuoy where we need to reach a further 881 million by 2015. We remain confident of our plans to scale up handwashing programmes at a faster rate over the next few years. Lifebuoy is focusing on the following priority areas to meet its target:
- increasing the impact of rural outreach through partnerships and multi-brand programmes
- creating larger partnerships with a pioneering approach to co-investment
- rolling out a cost-effective and scalable programme to new countries
- learning from evaluation studies to identify and roll out best practice
- continuing to raise the profile of hygiene issues with governments, key opinion formers and wider communities.
To help more than a billion improve their hygiene habits, we also recognise the need to develop a more holistic approach to the inter-related issues of water, sanitation and hygiene. We are looking at how we can promote affordable toilet provision and good toilet hygiene for millions while growing business for our Domestos brand. We are working with partners such as UNICEF and the World Toilet Organization to develop appropriate models to create and fulfil demand for toilets.