Handwashing Initiative (HWI)

Created in 2003, the national, multi-sectorial initiative focused in early years on: laying groundwork, including a formative research study in 2004; the creation of a consultative committee by the Ministry of Health (MoH); and a national decree formalising the HWI. In 2005, through support from the Japanese Social Development Foundation (JSDF) and based on the findings from the formative research, a programme methodology and supporting tools to promote handwashing were developed for use in small group discussions with mothers. Rather than following a traditional hygiene approach focused on germ theory, the methodology was designed to motivate mothers and strengthen their skills to manage soap for handwashing purposes. In parallel, a mass media campaign with the theme of Manos Limpios, Niños Sanos (Clean Hands, Healthy Children) was designed to raise awareness of the importance of handwashing with soap and its link with children's health. National broadcast of the mass media campaign, which included a radio soap opera and television and radio spots, began in 2005.

In 2007, a second phase began though support of WSP's Global Scaling Up Handwashing Project to expand handwashing with soap promotion to 24 of the country's 25 regions. Based on research revealing that there were misconceptions such as the belief that rinsing hands in water was sufficient to clean them and that handwashing with soap was necessary only when hands were visibly dirty, the project team developed a communications campaign featuring a superhero named Super Jaboncín (SJ) - loosely translated to "Super Soaper" - who gains the power to fight germs by adding soap to water. To bring SJ to life, three 30-second radio spots were developed: the first introduces SJ and his power (I discover the power); in the second, the audience learns they can appropriate SJ's power by using soap (I have the power); in the third, the listener lets others have the power of SJ (I share the power). Together, the spots mirror the development of a new social norm: that of handwashing with soap. The radio spots are designed to remind mothers of the 4 critical times to handwash with soap: after using the toilet, after changing a baby's diaper, before preparing food, and before eating. To build continuity from the first phase of the initiative, the radio spots and related print materials reprise the slogan from the first phase, Manos Limpios, Niños Sanos (Clean Hands, Healthy Children).

The SJ concept also forms the basis of direct consumer contact (DCC) events: fairs with simultaneous activities taking place, including games for children, live theatre, and kiosks where demonstrations and advice on where to place soap and how to set up a handwashing station can be shared with mothers. To facilitate implementation by various agencies, a kit was developed that includes: a SJ superhero costume, 3 games with large props to engage audience participation, support materials such as posters and comic strips featuring the SJ superhero to distribute to the audience, and a guide on how to use the kit materials and conduct an event.

According to organsiers, the facilitating agencies and regional coordinators play a pivotal role in this initiative - for instance, by engaging other partners to broaden the reach of the project and share tools that contribute to consistent messaging. They also train master trainers, who, in turn train the front-line workers - principally, health care providers, local community development workers, and teachers. The project developed a performance monitoring system to follow both the quantity of activities (outputs) and the quality of the intervention.

Children, Health.

In Peru, diarrhoeal diseases are one of the leading causes of morbidity in children under the age of 5. Though hygiene promotion had been implemented prior to HWI, the 2004 formative research study revealed that only 6% of mothers washed their hands with soap before cooking and only 14% washed their hands after going to the toilet.

By 2006, the programme methodology had been implemented in 14 regions, resulting in over 150,000 mothers reached through an estimated 9,000 trained field agents. In the second phase: an estimated 6.1 million population have been reached through the broadcast of radio spots; 230,000 people have been reached through DCC events; and approximately 217,000 mothers and children have been reached through some 21,400 trained front-line workers.