The promotion of hygienic behaviour – and particularly handwashing with soap – is one of the most cost-effective health interventions. Yet, despite bringing some of the highest public health returns on investments, hygiene is neglected – in public health interventions, in national and global health policy priorities, and in national and global monitoring frameworks.
Public policy efforts and government campaigns to promote hygienic practices and handwashing with soap capture a miniscule proportion of national health budgets and international aid spending on health – typically less than 1%. Part of the reason for the lack of funding is the uncertainty around what makes behaviour change campaigns a success and the prospect of a return on investments.
Hygiene promotion campaigns are often piecemeal, insufficiently planned and executed, and a re-tread of unproven or, worse, ineffective approaches. The lamentable performance of handwashing campaigns in changing behaviours reveals a lack of coherent thinking in policies, strategies and guidelines.
To promote an effective approach to mass behaviour change campaigning, and hygiene promotion in particular, WaterAid commissioned an in-depth global and historical analysis of behaviour change campaigns, analysing both successes and failures. This paper highlights the main points from that study combined with findings from a previous WaterAid paper on how some countries in East Asia successfully achieved the widespread adoption of hygienic practices. It provides policy recommendations as a set of ‘working assumptions’ that can be used by policy makers when it comes to developing mass behaviour change strategies.