WASH’ Nutrition

EXAMPLE FROM THE FIELD 15
Improving hygiene for better health and nutrition -
hygiene promotion through the routine immunization programme in Nepal
This pilot project was initiated in 2014 by the Nepal Ministry of Health and Population, Child Health Division and WaterAid to
determine an effective hygiene promotion intervention for nationwide implementation within the immunization programme. The pilot
is being conducted in four districts – Bardiya, Jajarkot, Myagdi and Nawalparasi targeting 35,000 mothers/caretakers with 0-12
month-old children, around 1,200 health workers and 2,200 female community health volunteers. The pilot has been designed to
define, test and implement a simple and scalable hygiene promotion package that can be delivered sustainably through the Nepali
health system. While traditional hygiene education approaches frequently focus on delivery in community or school settings, the
current hygiene promotion intervention will be delivered during immunization clinics. Nepali infants and their mothers/caretakers
attend immunization clinics at least five times within the first year after birth to fully immunize their children. The intervention is
based on the premise that time spent waiting in the clinics can be utilized to provide mothers/caretakers with further tools and skills
to protect their child’s health. It is also assumed that mothers/caretakers are more ‘susceptible’ to health-related messages in this
context than in a normal community setting; and that the immunization sessions offer a more regular ‘contact point’ for mothers/
caretakers and frontline health staff than usual. The hygiene promotion intervention is delivered by Female Community Health
Volunteers (FCHVs), a primary health cadre who provides basic promotion and treatment at the community level. While FCHVs
often provide volunteer support immunization clinics in addition to their routine roles, under the hygiene promotion project they
undertake a formal role of conducting hygiene promotion sessions at the start of each immunization session once a month using a
creatively-designed hygiene promotion intervention package.
This package goes beyond hand washing with soap and toilet use by further promoting nutrition-relevant behaviours such as
exclusive breastfeeding for the first six months of life, thorough cooking and reheating of food, and water/milk treatment. This
is done under a branded campaign titled “Clean Family, Happy Family”. The premise of the campaign is that attending all five
immunization sessions and practicing all five behaviours makes for an “ideal family”, an inspirational goal to attain. The package
tools include a mix of innovative, creative, simple-to-use promotion and demonstration aids (taking into account literacy levels of
FCHVs and mothers/caretakers by using locally-produced illustrations, and sounds), games, story-telling, hand-washing rituals,
competitions, commitment-making and certification for mothers/caretakers who have completed the programme. Additionally, to
serve as reminders for practicing behaviours in the household setting, mothers/caretakers are also provided with branded visual
aids that are used on a daily basis (fan for lighting fire and removing flies, wall mirror, and a bib for toddler feeding). Many of the
tools and demonstration techniques are linked with emotional drivers and change in behavioural settings.
Sustaining the motivation and engagement of FCHVs is a crucial component of the programme. Therefore, emphasis has been
placed on strengthening the skills of FCHVs through in-depth training, reinforcing social respect towards FCHVs, providing attractive
and enjoyable tools, and ensuring that FCHVs are paid incentives per activity delivered as set out under Government norms.
If proven effective, the approach will be scaled up nationwide in tandem with the introduction of rotavirus vaccines through the
immunization programme.
About the project: http://www.wateraid.org/policy-practice-and-advocacy/hygiene-promotion-through-immunisation
3.3. WASH kitS distribution in health care facilities
WASH kits distribution aims at ensuring access to safe water supply in the affected households and enabling mothers/caretakers
of admitted children to perform good hygiene practices during and soon after nutrition treatment (see also Chapter 3 on the
WASH minimum package to complement the treatment of SAM).
WASH kits should be provided at entry (admission) to the treatment in order to support the treatment rather than at exit (to
reward or to give an incentive against dropping out). Ideally WASH kits should be available at the health facility, to be provided
(by health/nutrition staff) directly with the first RUTF provision, or can be replenished for the second visit. Distribution volumes
are usually quite small and easy to process, compared to an emergency distribution. The general trend is to keep the content
simple, with the items available at an affordable price on the local market e.g. 500g soap for hand washing, 1 jerry can for
water carrying and household water treatment products for at least 2 months. 171 Some further guidance on how to design
the kit content:
171 - West and Central Africa Regional WASH Group (2015) “WASH in Nut” Strategy for Sahel
WASH’Nutrition
A practical guidebook
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