The Global Public-Private Partnership for Handwashing with Soap

Nepal

Project status:	Started in 2003
Need (CMR, IMR, DD morbidity & mortality):	Child mortality: 28,000/year and 91 deaths/1000 live births due to diarrheal diseases (DHS 2001). Under 5 morbidity: One in five children suffered from diarrhoea in the 2 weeks before the survey. Diarrhoea incidence varies with age. Prevalence is highest among children age 6-11 months (35%). Children living in households where the main source of drinking water is from a well are more prone to diarrhoea than children living in households with access to piped drinking water (DHS 2001). 10 million episodes of DD/year. DD are over 1/3 of all childhood diseases in Nepal (UNICEF 1996). 17% diarrhoea prevalence in rural, 12% in urban areas. Higher prevalence in children of illiterate mothers (17%) than literate ones (14%). (2000 Nepal BCHIMES)
Demand (as expressed by beneficiaries) Rationale:	Past projects focused on latrine construction. In recent years it has been understood that facilities alone cannot reduce the disease burden significantly and that it is necessary to try to alter peopleís hygiene behavior. The existing Steering Committee for National Sanitation Action expressed interest in the PPPHWI. The National Sanitation Campaign launched in 2000 with support from UNICEF promotes sanitary and hygienic practice (including handwashing) but so far, has only been a public sector initiative, with no involvement from the private sector.
Drivers/obstacles to handwashing with soap:	NB: Handwashing Behavior Study ongoing. HWBS objectives:  1. To establish a baseline on the diarrheal incidence of children under 16 (with a focus on children under 5), awareness and practices of handwashing with soap 2. To gather and analyze information and content of various components required for the development of the media strategy. Previously available data show: 93.2% respondents washed hands before eating 97% wash hands after defecation 56.9% used soil and water to wash hands after defecation 22.2% used soap and water to wash hands Environment: 27.1% of rural households have access to latrines (2000). Handwashing is most often practiced for purification purposes, without the use of clean water, detergent or towel. Soap is used for many purposes but not necessarily handwashing. There are noticeable differences in handwashing practice by literacy status. (1994 KAP study)
Program Goal:	To contribute to the reduction of diarrheal incidences through handwashing with soap at critical times and using correct techniques.
Campaign Objectives:	Campaign objectives:   To generate awareness on the importance of handwashing with soap. To gradually inculcate the habit of handwashing with soap among the target groups. Reach 5 million people including 500,000 school children.
Communication materials and events::	IEC, advocacy, posters, brochures, flip charts, soap samples, radio spots/jingle, radio and TV advertisements, primetime television and radio programs, door-to-door visits, handwashing demonstrations and activities in schools and communities, events in the program districts, mobilization of frontline workers such as female community health volunteers, sanitation motivators, and community-based organizations, launch events.
Outcome:
Contact person::	Siddartha Shrestha, UNICEF: sidshrestha@unicef.org
Participation: - community - public sector - private sector - international partners	Lead Agency: UNICEF Phase I: February-August 2003 World Bank: Grant to UNICEF. Contributes also through sharing experience gained from other countries. UNICEF Nepal-CWE Section: Coordination, planning, facilitation, Task Force management, full-time Coordinator post. Link with National Sanitation Campaign 2001-2005. Continuation of the project over min. of 18 months subject to available funds (phase II: 2003-Dec 2005) USAID/EHP: Design, development, oversight of Handwashing Behavior Study, technical assistance for results analysis and development of communication strategy. M&E oversight.
Key documents:
Related links:	Nepal Sanitation Campaign
Latest update: (August, 2005)	The first phase of the Initiative comprised of a consumer baseline survey and the development of a Business Plan. Based on the findings of the survey, a marketing strategy was developed including IEC and promotional materials viz. posters, brochure, flip chart, radio spots/jingle and a TV commercial. The Nepal Handwashing Initiative was launched nationally in October 2004 followed by the district level launches. The Handwashing Initiative was launched using mass media advertising (TV, Radio) and social mobilization, which included training of frontline workers (Female Community Health Volunteers, Sanitation Motivators, and Community Based Organizations etc.), door-to-door visits, hand washing demonstrations and activities in schools and communities, and local event promotions in the focus program districts. All these activities are being organized in a continued manner. Monitoring and reporting at the community, district and central level is been organized on a regular basis during the implementation phase. There are two major soap manufacturers involved in the Initiative: Nepal Lever Ltd. (a subsidiary of Unilever Inc.), the market leader in the soap segment and a local soap company, Aarti Soap and Chemicals. They have supported the campaign by providing free media airtime in prime time television and radio programs, soap samples and school promotions. During the recently concluded National Sanitation Action Week in May 2005, handwashing with soap promotion was incorporated as an integral component, particularly among the school children, in a majority of the districts.