The Global Public-Private Partnership for Handwashing with Soap

Ghana
Project status:	On-going
Need (CMR, IMR, DD morbidity & mortality):	Under 5 mortality: c. 84,000/year, 25% of deaths Morbidity: Over 9 million episodes of diarrhoea annually. Morbidity increased from 4.6% in 1996 to 5.3% in 2000.
Demand (as expressed by beneficiaries) Rationale:	Community Water and Sanitation Agency (CWSA) expressed interest in piloting the Initiative at the 2001 World Bank Water Forum, Washington for: Reducing infant mortality and morbidity is a key target of the Ghanaian government's poverty reduction strategy. The rural water sector strategy integrates water, sanitation, and hygiene to achieve maximum health impact. Hence, handwashing appears naturally in line with the strategy. Handwashing with soap complements CWSA's activities. Soap market study shows Ghanaians are major consumers of soap per capita.
Drivers/obstacles to handwashing with soap:	The handwashing behavior study carried out in 2002 in four districts suggested that: 24% of mothers of children under five washed hands with soap after after using the toilet; 41% used water alone. 16% of mothers washed hands with soap after cleaning up a child who has defecated; 28% used water alone The study showed that handwashing is acceptable and widely practiced, but soap use is not a habit. It also revealed that the habit of handwashing with water alone has often been inculcated from an early age. The drivers handwashing with soap include found were: Disgust: Removing grease and pepper from hands after eating. After contact with public toilets, the desire to remove visible, olfactory, tactile and imaginable contaminants from hands and to make one feel fresh and clean and boost confidence.  Nurture and health: Childrenís stools were not thought smelly or dangerous, however, the highest priority for mothers was the care and nurture of their children. Status and attractiveness The identified constraints to handwashing were that soap is often kept hidden away so as to prevent misuse; hence it is not readily available for handwashing, though water is generally available. Strong scented soaps were not preferred for handwashing, as they interfere with the taste of food, while small sized and liquid soaps are preferred.  Soap features: Perfumed soaps are luxury items to be kept safe from children and thought to spoil the taste of food if used before eating; Multipurpose soap is used for all activities including handwashing; Laundry soaps are thought better for use prior to eating; Toilet soaps are preferred post-defecation because of powerful smell (HWBS, January 2002)
Program Goal	The Ghana initiative is aimed at reducing morbidity and mortality among children under 5 years through an integrated communication campaign promoting hand washing with soap to prevent diarrheal diseases.
Campaign objectives:	The key program objectives are to: Increase the practice of handwashing with soap among mothers and care-givers of children under five years, especially after cleaning up a child from 16% to 50% in two years. Increase the number of school children aged 6-15 years who wash their hands with soap especially after using the toilet from an estimated 20% to 50% in two years. Program paying for itself in savings in health care and lost days of work. Communication objectives are: To create awareness on the benefits of handwashing with soap among 50% of mothers and care-givers of children under five years and 50% of school children aged 6-15 years in the first year and raising it to 80% in the third year. To increase the practice of handwashing with soap at critical times among mothers and caregivers of children and school children aged 5-16 years by 50%.
Communication materials and events	Car stickers, posters, poster stickers, advocacy leaflets, folders, bounty packs for mothers, billboard, badges, T shirts, caps, polo shirts, handwashing basins/buckets, bars of soap, training materials for teachers and school health coordinators, newsletters / quizzes / prizes, advocacy materials, handwashing "information cards", mass media, launch event, DCC events (e.g. drama).The Ghana initiative is aimed at reducing morbidity and mortality among children under 5 years through an integrated communication campaign promoting hand washing with soap to prevent diarrheal diseases. Ghana TV advertisements (Real Media files) Children (1662kb)   Mothers (1771kb)
Outcome:	Contribute to realizing Ghana's target to reduce Under Five Mortality Rate from 110/1000 in 2000 to 95/1000 in 2004.
Contact person:	Nana A. Garbrah-Aidoo, CWSA: handwash@ghana.com
Participation - community - public sector - private sector - international partners	Lead Agency: Community Water and Sanitation Agency, Minister of Works and Housing 2 year campaign (2003-2005) Public sector/World Bank: Campaign funded through National Community Water and Sanitation Program's funds (NCWSP II). Ministry of Health: Contributes through existing resources (e.g., local health services) Ministry of Education: Contributes through the School Health Education Program Private sector: Technical assistance for campaign design, testing, and implementation; in-kind. External Support Agencies:   UNICEF: Support to schools component. DANIDA: Support to schools component
Key documents:	Handwashing Behavior Study Analysis (December 2002) Business Plan   "PPPHW program: the story of Ghana" PDF: 109KB
Related links:	The World Bank Group in Ghana
Latest update: (August 23, 2005)	The Ghana Public-Private Partnership to Promote Handwashing with soap crafted a high-impact communication strategy with the slogan "For truly Clean Hands, always wash with soap ". Phase One of the campaign was implemented from September 2003 to August 2004. The Initiative has implemented a highly professional communications program. The program uses the power of commercial marketing, through three main integrated communications channels: mass media, Direct Consumer Contact, and a district level program through schools, health centers and communities. The communication strategy, in addition, includes a Public Relations and Advocacy component that targets policy makers and opinion leaders and promotes the provision of handwashing infrastructure in schools and public latrines. Mass Media: During Phase One of the campaign, the program utilized state-of-the-art marketing strategies to promote handwashing with soap based on concepts that are most effective with mothers and basic school children. The campaign materials focused on disgust based on nurture as the key driver for behavior change for mothers and caregivers and on disgust based on acceptance by family for children. The guiding concept for this phase of work was "your hands are only truly clean if washed with soap ". Two radio adverts and two TV adverts were produced. The two radio adverts and one of the TV advert targeted mothers and caregivers, while the remaining TV advert targeted children. The radio and television adverts were supported by posters and billboards sited in all 110 district and 10 regional capitals of the country, and the distribution of below-the-line materials such badges, T shirts, branded poly bags and soap. The radio and TV adverts ran for six months with a blitz in the first three months of the campaign. Direct Consumer Contact: An event management firm visited two districts per region in six regions in Phase One and conducted 128 high-impact events in schools to reach 103,313 school children, 2,930 teachers and 926 food vendors, and 132 events in health centres and communities for 11,500 mothers. DCC is used as an interpersonal communication strategy that provides information on handwashing with soap in an innovative and interactive manner and provides a platform for the audience to have any concerns and/or questions addressed. District Level Program: Handwashing Steering Committees in Ghana’s 110 districts developed handwashing action plans for implementation of the District Level programme. Each district has been supported with funding from the World Bank Assisted Community Water and Sanitation Programme Phase Two (CWSP II) to organize a district launch event. In addition, orientation workshops were held for members of district and regional steering committees on the vision, objectives, rationale and strategy for the PPPH Initiative in Ghana. The objective of the District Level Program was to ensure that all government facilities, health centres, schools, community infrastructure deliver the handwashing with soap message; advocate for the provision of handwashing facilities and soap in public and school toilets, especially as over 60% of the target audience use public toilets. District-level activities to support the campaign continued throughout 2004 and the first half of 2005. Public Relations and Advocacy: Targeted at opinion leaders and strategic audiences, this strategy component delivered continued press and media coverage in support of the aims of the handwashing campaign. A number of radio and television talk shows and interviews were broadcast on national media and district-specific FM radio stations. An advocacy brochure that outlined the strategy for the initiative was also produced and distributed to strategic audiences and partners. The evaluation of the first six months of the communication campaign, undertaken in August 2004, confirms that the campaign has on the whole been effective in creating awareness about the importance of and critical times for washing hands with soap. However, to maintain visibility, promote behavior change, and maintain handwashing with soap, the PPPHW Initiative needs to continue to remind target audience of the handwashing with soap message . In the first half of 2005, the mass media program was back on air on Ghana Television (GTV), the national television station, to re-echo the handwashing message to the target audience. In January 2005, there was a repeat broadcast of the television discussion program in the six main local languages. In addition, several feature articles about the program appeared in a number of newspapers including two widely-read ones: Junior Graphic, a weekly paper targeted at school children, and Public Agenda, a bi-weekly private newspaper targeted at opinion leaders.