We share learnings to inform future responses to global health crises, including why handwashing is the simplest and most cost-effective way to avoid millions of preventable deaths.
Hygiene & Behaviour Change Coalition
The Hygiene and Behaviour Change Coalition (HBCC)
In response to the COVID-19 pandemic, Unilever and the UK Government’s Foreign, Commonwealth & Development Office (FCDO) joined forces to limit the spread of the virus in low- and middle-income countries. Between March 2020 and December 2021, this award-winning public-private partnership has reached more than 1.2 billion people with lifesaving behaviour-change messaging, hygiene products and access to training and education.
Back in 1894, Unilever helped to improve hygiene with Lifebuoy soap during the cholera epidemic that was sweeping across Victorian England. 126 years later, Unilever is helping to stem the spread of the global COVID-19 pandemic with hygiene interventions. Through the Hygiene and Behaviour Change Coalition (HBCC) created by Unilever and the UK Government’s Foreign, Commonwealth & Development Office (FCDO), Unilever with its hygiene brands, including Lifebuoy and Domestos, have helped to reach over 1.2 billion people with hygiene behaviour programmes and awareness campaigns.
“Our business has a century-long history of promoting hygiene through our brands, but this unprecedented crisis called for an unprecedented response,” says Rebecca Marmot, Chief Sustainability Officer, Unilever.
Handwashing and hygiene: the backbone of the fight against COVID-19
Handwashing and hygiene are two of the most effective, affordable and easiest ways to help reduce the spread of germs. It was with the aim of helping as many people as possible adopt good hygiene habits that the FCDO and Unilever jointly launched the up to £100 million global partnership effort in March 2020.
Since then, Unilever, with its expertise in hygiene behaviour change and mass media communications, has worked with 21 NGOs and UN partners via the multi-award winning HBCC partnership to implement on-ground programmes and run mass media campaigns, aimed at raising hygiene awareness and teaching hygiene principles.
Unilever’s hygiene brands Domestos and Lifebuoy have a long history of hygiene programming. The HBCC projects have been established using these existing evidence-based programmes, benefiting from proven behaviour-change methodology.
HBCC hygiene campaign: Hands–Face–Space–Surface
Unilever also led the creation of a bespoke, global hygiene campaign for the coalition: The PASSWORD ‘Hands–Face–Space–Surface’ teaches and reminds people of the importance of key hygiene behaviours in the fight against COVID-19. It was translated into more than 30 languages, aired in over 18 countries and reached up to 200 million people. The campaign was offered to NGO partners to use for free, and they were supported by Unilever media experts on planning and airing of the campaign for best visibility and uptake.
Through the HBCC initiatives, over 250,000 handwashing stations have been installed around the world and over 450,000 community health workers and teachers have been trained to deliver information on the importance of correct hygiene practice. More than 78 million Unilever hygiene products, including Domestos bleach and Lifebuoy soap and hand sanitiser, have also been donated and distributed in over 60 countries.
Reaching those most in need
The HBCC was designed to reach populations and communities whose living conditions increased their susceptibility to contracting Covid-19 and other infectious disease. NGO and UN partners were selected based on their experience and expertise in delivering programmes to vulnerable communities, like refugees.
Working with partners such as the UN Refugee Agency (UNHCR) and the International Rescue Committee (IRC) allowed the HBCC to establish specialist programmes that effectively supported people living through some of the world’s worst humanitarian crises, including in Cox’s Bazar in Bangladesh. Over 30 million Unilever hygiene products were donated to UNHCR for direct distribution to refugee communities.
The power of public–private collaboration
Of course, the huge scope and the quick deployment of the HBCC programme would not have been possible without the close collaboration of the public and private sectors. Unilever’s partnership with the FCDO, supported by academic experts in behaviour change and WASH (Water, Sanitation and Hygiene) at the London School of Hygiene & Tropical Medicine (LSHTM), represents the UK’s largest public–private partnership established to help slow the spread of the virus in vulnerable countries.
“Public–private partnership has been critical, allowing us to leverage the influence, expertise and networks of both government and business, and our strong network of NGO and UN partners, at home and overseas. We’re pleased to work together with partners to implement initiatives to address the pandemic at scale,” says Rebecca Marmot, Unilever’s Chief Sustainability Officer.
The HBCC continues
Experts agree that hygiene, alongside free and universal vaccination programmes, will continue to be of fundamental importance in the long-term response to COVID-19. Continued focus on hygiene is especially important where vaccines are not readily available. For countries that are eyeing post-pandemic life, maintaining focus on hygiene will be vital in helping people continue to live happy, healthy lives.
We know that there are large inequalities in access to hygiene and sanitation. Three in ten people do not have access to soap and water in their homes, and one in three healthcare facilities does not have access to hand hygiene where care is provided. It is our hope that one silver lining from this crisis may be recognition at a much greater scale of the vital role hygiene plays in health.
In early 2022, Unilever and the FCDO extended the HBCC in response to Omicron and other new COVID-19 variants. This second round of the HBCC is designed to support preparedness for future health-related crisis by strengthening local capacity. Working with ten UN and NGO partners across 18 countries the programme also combines measures to tackle COVID-19 vaccine hesitancy and encourage vaccine uptake where appropriate.
Three steps to keep UN SDG 6 on track
Together we can ensure that within 10 years, every single person on our planet can perform one of the simplest lifesaving acts, and that no child dies because of lack of access to water, sanitation and hygiene. We are asking the global community to take the following steps and achieve this crucial target.
- Make and publish costed plans with clear deadlines: The adoption of costed national plans for water, sanitation and hygiene will ensure plans and finance go hand in hand. This will galvanise support and spur effective interventions.
- Financial investment: Governments, donor agencies and local funding allocators must prioritise their investment in hand hygiene services and behaviour change around the world. NGOs must prioritise these activities, providing the expenses and support that will enable further investment, in particular to households, schools and healthcare settings.
- Partnerships: More ground-breaking collaborations are urgently needed across the public and private sector, NGOs, academics and civil society organisations. By collaborating across sectors, we can pool our expertise and resources to great effect.
HBCC Case Studies (3 items)
Equal distribution of care work and hygiene responsibilities (1 of 3)
In many parts of the world, men still rarely contribute to household chores. Both men and women commonly have the perception that men should be the breadwinner and work outside the home, whereas women should be responsible for all domestic tasks and childcare. This also extends to being responsible for hygiene, keeping the home clean and teaching children good hygiene behaviours.
We saw women being disproportionately affected by the pandemic as additional hygiene and caring responsibilities fell to them. In order to change this and to encourage more engagement from men Oxfam started involving men in their programme. This programme is developed by Oxfam and Lifebuoy to encourage handwashing with soap in emergency affected communities to prevent the spread of diseases. While a wide variety of topics were covered such has Covid preventative methods and good hygiene practices, special focus was given to the importance of equal distribution of domestic work. Different methods and tools were used to sensitize and motivate men to change their behaviour. Although shifting such deeply entrenched social norms takes time and effort, Oxfam are already seeing some changes in the community. Men are now taking care of their children and helping women in household chores like sweeping and house cleaning.
COVID-19 superheroes in Pakistan (2 of 3)
With a virus spreading all over the world, there hasn’t been a more dire need for a superhero. In Pakistan, IRC has a team of five! Building on Unilever's School of 5 hygiene programme, IRC created 5 fictional heroes to talk about the preventive measures for COVID-19 and to save the youth from this horrendous pandemic. The superhero team is now a unique force of courageous individuals who are determination to fight this pandemic. The lead of the team is Pakistan’s first animated transgender character, ‘Bijli’. Bijli is joined by Ali, a young Pashtun who loves playing the rubab and uses music as a tool to connect with people. Akifa is a young Sindhi student who uses her intellectual abilities to fight for what is right. Maham is an independent woman who is proud of her body and advocates for life positivity. And lastly, Soomro is a Sindhi genius, who while being wheelchair-bound, still manages to use his gadgets to fight for good.
Inclusive handwashing stations (3 of 3)
WaterAid worked in collaboration with people living with disabilities to design handwashing stations that are fit for their specific needs. The new handwashing stations offer both handwashing and sanitising options and the provision for dispensing tissues. Signage helps all users see how to use the facility, including visual cues and nudges for handwashing on the water tank to support hygiene behaviour change. The inclusive handwashing facility above has an access ramp making it accessible for people on crutches or using a wheelchair. It has a slot for storage of liquid soap. The facility has two levers which can be pressed either using the knee, feet or hands making it easy to use by both people living with disability and those who are not. Both facilities are also equipped with foot levers for other users.
To find out more about specific programmes click on the partner logos below:
ActionAid (1 of 21)
ActionAid reached over 28 million people in Kenya and Nepal, with a focus on supporting women and girls. The organisation used mass media and digital channels to raise awareness of the hygiene behaviours to help people protect themselves against COVID-19. ActionAid also repaired safe water sources to ensure communities have access to clean water for handwashing. In addition, ActionAid has used its networks to give out tens of thousands of soap and surface cleaning products donated by Unilever to the communities where they were needed most. By taking a community-led approach ActionAid worked with local women leaders on secondary impacts of the pandemic, including domestic violence.
AGA Khan Foundation (2 of 21)
In the first round of HBCC, Aga Khan Foundation (AKF) primarily worked with rural, at-risk communities across six Indian states. They provided critical information on how to improve and sustain hygiene behaviours, reaching over 40 million people. By using simple tools such as wall paintings and posters, and by working through local groups, AKF were able to spread hygiene and health messages to remote communities.
They also supported the government in creating better access to clean toilet, handwashing and drinking water facilities. AKF did this by building soap-banks and handwashing stations in community spaces, such as centres for children and healthcare facilities.
AMREF (3 of 21)
In the first round of HBCC, Amref worked with local partners to support the governments of Kenya, Uganda, and Tanzania to promote hygiene behaviour change to curb the spread of COVID-19 infections. They reached over 67 million people, with a particular focus on helping people with disabilities and other marginalised groups.
Amref promoted effective hygiene behaviours using mass media, digital and social media communication. They also used alternative and engaging ways to communicate, like sharing hygiene messages in a popular puppet show for children, and delivering interactive learning on mobile devices.
Amref are continuing their work with the HBCC in its second round in Kenya, Uganda and Tanzania.
BBC Media Action (4 of 21)
In the first round, BBC Media Action reached over 12 million people, driving long-term change in handwashing and hygiene behaviours across Afghanistan and Somalia, while also tackling issues such as stigma and discrimination that can act as a barrier to these behavioural changes.
With over 20 years of health communication experience, as well as considerable expertise in the use of mass media channels, BBC Media Action is a leader in the use of digital tools to encourage behavioural change that can have a direct impact on public health outcomes. Supported by high-quality BBC production values, BBC Media Action’s resources attract and engage wide audiences across the world.
BBC Media Action are continuing their work with the HBCC in its second round, working in Ethiopia and Somalia.
BRAC (5 of 21)
In the first round, BRAC worked in collaboration with the Behavioural Insight Team (BIT) reaching over 100 million people across Bangladesh to help change their hygiene practices.
As well as setting up handwashing stations across Bangladesh, BRAC encouraged long-term behaviour change through a communications strategy in two stages. First, they used mass media and digital communications to share simple messages around hygiene, social distancing and environmental practice. These messages were followed up during in-person communications activities that aimed to convert the newly adopted hygiene behaviours learned from the mass media communication into long-term personal habits and social norms.
BRAC are continuing their work with the HBCC in Bangladesh in the HBCC’s second round.
CARE International (6 of 21)
Reaching over 28 million people, CARE International UK worked with governments and local influential actors to reach vulnerable people across Rwanda, Somalia, Zimbabwe, North-Eastern Syria, and Jordan to minimise the transmission and damaging impact of COVID-19.
Through mass and digital media campaigns and face-to-face interactions they provided critical, inclusive and gender-sensitive messages about COVID-19 prevention measures. By answering questions and concerns at a grassroots level and opening up a community dialogue, CARE encouraged positive behaviour change whilst quelling the potentially negative impact of rumours and stigmatisation surrounding transmission of COVID-19.
The German Agency for International Cooperation (GIZ) (7 of 21)
Reaching over 23 million people in Indonesia and the Philippines, GIZ worked with Domestos to help prepare schools to safely reopen and continue to be safe spaces during and beyond the pandemic.GIZ did this by designing scalable pandemic preparedness and response measures, including information packages on hand hygiene, surface cleaning and disinfection procedures. These packages were tested and shared with the Ministries of Education in both countries to ensure pandemic preparedness was integrated across the education system, encouraging a higher rate of compliance in schools.
International Rescue Committee (IRC) (8 of 21)
The IRC's hygiene promotion programme directly supported over 18 million refugees and people that have been displaced from their homes across Bangladesh, Pakistan, and Myanmar, with a particular focus on women and girls.
Using mass communication channels such as radio, TV and social media IRC promoted good handwashing habits, giving out hygiene kits with products such as soap, hand sanitisers and surface cleaners, and encouraging people to make use of handwashing facilities and sanitisers to keep their hands clean, use face masks and keep a safe distance in public places.
IRC WASH (9 of 21)
In Burkina Faso poor hygiene practices and little access to clean water and handwashing facilities play a major role in diseases spreading.
To combat the spread of COVID-19 in the country IRC WASH used its networks and expertise to quickly deliver hand hygiene and surface hygiene messages to over 11 million people across two key regions of the country. Their social media campaign helped raise awareness of COVID-19 protection measures and they worked with government and local utilities companies to ensure that people in rural communities had access to government-funded water, sanitation and hygiene services.
London School of Hygiene and Tropical Medicine (LSHTM) (10 of 21)
The London School of Hygiene and Tropical Medicine (LSHTM) supports the whole HBCC coalition as a technical partner by providing information resources, practical guidance and technical advice to optimise the hygiene activities, messages and campaigns delivered by everyone involved in the coalition.
In addition, during the first round of HBCC LSHTM worked directly in Zambia and Tanzania using mass media and social media to share the ‘‘PASSWORD’ campaign. They reached over 50 million people, working closely with the countries governments to adapt the campaign for optimal uptake and use.
Oxfam (11 of 21)
Oxfam worked to improve hygiene and health behaviours, reaching over 14 million people across Nepal and the Philippines, helping to reduce the transmission of COVID-19 while also promoting positive gender norms through their activities.
Working together with local authorities Oxfam helped to improve better handwashing behaviours at a community level. Oxfam also gave out hygiene kits with products such as soap, hand sanitisers and surface cleaners, and set up handwashing facilities across communities. They trained local volunteers on good surface hygiene to safely clean public spaces and how to teach these practices to local retailers, vendors and shop keepers.
PLAN International (12 of 21)
COVID-19 made it harder for young women and girls to protect themselves and their families which is why Plan International in Sierra Leone used digital and mass media channels to share messages about safe hygiene practices, reaching over 11 million people. They also provided soap and other hygiene products to help people practice these hygiene habits.
In addition to this, Plan International worked closely with the elderly, people with disabilities and their carers to ensure their concerns were being heard and hygiene messages were adapted to their needs.
Population Services International (PSI) (13 of 21)
In the first round of HBCC, PSI worked closely with partners in India, Kenya, Myanmar, South Africa, and Vietnam to align with the national COVID-19 response in each country, giving out critical hygiene and sanitation products and sharing educational messages to over 158 million people.
With many people to engage in both urban and rural areas the organisation used TV, radio and digital media channels to share information as widely as possible on how to prevent infections.
PSI are continuing their work with the HBCC in its second round, working in India, Kenya, Nigeria, Uganda and South Africa.
Save the Children (14 of 21)
In the first round, Save the Children worked to combat the spread of COVID-19 by improving the hygiene and handwashing practices of those who had little access to water and hygiene facilities, helping children and their families stay safe from infection.
The programme reached over 315 million people across nine countries: Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, South Sudan, and Yemen.
Save the Children are continuing their work with the HBCC in its second round, working in Ethiopia, India, Pakistan and Zimbabwe.
Sesame Workshop (15 of 21)
In the first round of HBCC, Sesame Workshop created video, print and digital educational material for children and their parents with messages on how to help curb the spread of COVID-19 and diminish the impact of the virus on families in Jordan and Syria.
Sesame Workshop used its experience of creating educational messages featuring well-known Sesame Street characters to share important hygiene behaviour messages in a fun and entertaining way, reaching up to 17 million people.
Sesame Workshop are continuing their work with the HBCC in its second round, working in India and South Africa.
SNV (16 of 21)
SNV worked in Mozambique and Indonesia creating tailored COVID-19 prevention messages for women, people with disabilities, school children, frontline workers and cleaners working in schools and public spaces such as transport hubs and markets.
They used a wide variety of channels and methods to get the message out to as many people as possible, and reached over 34 million people over the course of the programme.
UNICEF (17 of 21)
In the first round of HBCC, UNICEF reached over 50 million people, working closely with governments in 20 countries (Brazil, Cameroon, Colombia, DRC, Ethiopia, Fiji, India, Indonesia, Iraq, Kiribati, Myanmar, Nepal, Nigeria, Pakistan, Papua New Guinea, South Africa, Sri Lanka, Uganda, Venezuela, and Zimbabwe) to promote good hygiene and help tackle COVID-19.
UNICEF are continuing their work with the HBCC in its second round, working in Cameroon, DRC, Ethiopia, Nigeria, South Africa, Uganda and Zimbabwe.
UNHCR (18 of 21)
UNHCR worked to limit the spread of COVID-19 amongst refugees in the Democratic of Congo, South Sudan, Bangladesh and Cameroon, reaching over 19 million people. They did this by sharing messages on good hygiene behaviours, social distancing and the importance of mask wearing through different mass media and social media channels, working with local communities and health workers, local volunteers and religious leaders. They also gave out hygiene products such as soap and hand sanitisers to help people clean their hands.
WaterAid (19 of 21)
In the first round of HBCC, WaterAid worked in Ethiopia, Ghana, Nepal, Pakistan, Tanzania and Zambia where they reached over 228 million people. Working closely with government, schools, healthcare centres and places of worship the organisation delivered important handwashing education messages.
WaterAid are continuing their work with the HBCC in its second round, working in Ethiopia, Nepal, Nigeria and Zambia.
World Vision (20 of 21)
World Vision promoted preventative measures to stop and slow the spread of COVID-19, working closely with families and wider communities in the Democratic Republic of Congo to reach over 6 million people.
By equipping trusted community leaders, multi-faith leaders and community care workers with life-saving messaging on how to respond to COVID-19, World Vision were able to help many vulnerable households. World Vision also gave out handwashing kits with products such as soap, hand sanitisers and surface cleaners to families and used mass media to share important hygiene messages.
WSUP (21 of 21)
In the first round, WSUP worked in Kenya and Ghana to help low-income people in cities protect themselves and their communities against COVID-19. They used social media, local radio and television to share information on good hygiene behaviours such as handwashing, keeping social distance and wearing masks. WSUP collaborated with government, utility companies and community organisations to ensure this information was accessible to people with disabilities, the elderly and other marginalised groups.
The organisation also helped people gain access to safe water and facilities to wash their hands, and provided Personal Protective Equipment like masks and gloves to frontline workers. In total they reached over 20 million people across the two countries.
WSUP are continuing their work with the HBCC in its second round, working in Ghana and Kenya.