technologies, designs <strong>and</strong> local maintenance, management <strong>and</strong> financing arrangements.Users need to underst<strong>and</strong> the implications of each choice in terms of costs, durability,feasibility <strong>and</strong> the benefits <strong>and</strong> limitations for socio-economic development <strong>and</strong> health.Local capacities for maintenance <strong>and</strong> management must be developed. Only wheninfrastructure is well chosen, maintained <strong>and</strong> managed from the perspective of the differentuser groups can hygienic use be promoted.Poor drainage at water points creates new health hazardsIt is critical that promotion of better personal hygiene should not increase the health risksfrom other related sources. There is, for example, the danger that encouraging people tobathe at water points may lead to stagnant water pools. They provide breeding grounds formosquitoes that transmit malaria, filariasis <strong>and</strong> dengue. In semi-arid areas of India, thenumber of cases of filariasis multiplied when piped water supplies were installed withoutproper drainage <strong>and</strong> drainage management (Wijk, 1998). In the case of malaria, those whohave not yet built up their resistance (young children) or have lost it (e.g. HIV-infectedwomen <strong>and</strong> men <strong>and</strong> the elderly) run the greatest risks. In Africa, one in four childhooddeaths is attributed to malaria. The point here is not that bathing at water points should bebanned; it is that the water points should be designed to permit bathing, with appropriatedrainage of the wash water. Gender considerations are important too. A project orcommunity rule that simply forbids women from washing at water points for fear ofdrainage makes no sense when it means that the women have to carry all water forwashing <strong>and</strong> bathing home (where drainage may be inadequate anyway, so the same risksapply).The important lessons are that hygiene promotion cannot replace participation of thedifferent user groups in the planning <strong>and</strong> design of community water supply <strong>and</strong> sanitationprojects <strong>and</strong> that to obtain the optimum benefits from good hygiene, improved hardwarehas to reach all households in the community. Keeping up coverage is as important forhealth <strong>and</strong> economic reasons as it is a matter of social necessity.EHP has introduced a conceptual framework for ensuring that hardware, software <strong>and</strong> theright enabling environment are combined in WSH programmes. This <strong>Hygiene</strong> ImprovementFramework, illustrated in the next paragraph, was the topic for an electronic conference inMarch 2002.<strong>Hygiene</strong> Improvement FrameworkField studies have demonstrated that water supply, sanitation <strong>and</strong> hygiene can each be aneffective means to prevent diarrhoea. These studies point to two conclusions. First,improved water quality <strong>and</strong> quantity prevent diarrhoea, but excreta disposal <strong>and</strong>h<strong>and</strong>washing also have a significant impact. Second, interventions aimed at hygiene suchas h<strong>and</strong>washing can have as big an impact in preventing diarrhoeal diseases as hardware.For those interested it is available in word as well as a .pdf:• <strong>Hygiene</strong> Improvement Framework (Word file - 987KB)(http://www.ehproject.org/pubs/globalhealth/hif-bw.doc)12 <strong>Hygiene</strong> promotion
• <strong>Hygiene</strong> Improvement Framework (PDF file - 419KB)(http://www.ehproject.org/pubs/globalhealth/hif-bw.pdf)The Environmental Health Project (EHP) has developed the <strong>Hygiene</strong> ImprovementFramework (HIF) as an integrated approach to prevent diarrhoeal disease. This frameworkhas three components: access to hardware, hygiene promotion, <strong>and</strong> an enabling policy<strong>and</strong> institutional environment.HIF E-Conference ConclusionsThe <strong>Hygiene</strong> Improvement Framework is a useful conceptual model for planning <strong>and</strong>implementing WS&S projects. The three components, access to hardware, hygienepromotion, <strong>and</strong> enabling environment, are all appropriate.Health <strong>and</strong> hygiene efforts can have positive results even when not accompanied byhardware interventions in sanitation <strong>and</strong> water provision. However, an integratedprogramme with all three components is the ideal.Figure 2. The <strong>Hygiene</strong> Improvement FrameworkThe focus of hygiene promotion should be on changing key behaviours. These includeh<strong>and</strong>washing after defecation <strong>and</strong> before h<strong>and</strong>ling food, use of latrines, <strong>and</strong> keeping waterfree from faecal contamination. A guide to Improving health through behavior change hasnow been developed based on work done especially in Latin Americahttp://www.ehproject.org/PDF/Joint_Publications/JP007-CIMCIProcessGuideWeb.pdf<strong>IRC</strong> <strong>International</strong> <strong>Water</strong> <strong>and</strong> <strong>Sanitation</strong> <strong>Centre</strong> 13
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TOP Courses and conferencesCREPA, B
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TOP ReferencesBoot, Marieke T. and
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TOP Quiz on Hygiene PromotionTry it
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Question 4All the interventions wil
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Then you may decide that this paper
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Appendix 1. Hygiene promotion manua
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2. Target specific audiences.These
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Appendix 4. WASH facts and figures1
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Research)18: (IHE Newsletter, Janua
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Appendix 6. Preventive measuresMeas
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Appendix 8. Some key objectives for
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Appendix 9. Participatory tools and
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Appendix 10. The PHAST approachFor
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Planning techniques are used to sim
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While sensitive topics are often be
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About IRCIRC facilitates the sharin