WATer AnD SAnITATIon ProGrAm: Learning note 56969 Global Scaling Up Handwashing Project Key findings Involving Men in Handwashing · In Senegal, men are typically heads of household. In this role, they act as Behavior Change Interventions gatekeeper, protector, and role model, exerting influence over household in Senegal activities such as finances, social interactions, and behaviors. June 2010 · Senegalese men have expressed frustration at not being included in handwashing promotion discussions. INTRODUCTION Thus, both men and women should Launched in December 2006, the and HIV/AIDS prevention. The main be targeted in handwashing behavior Water and Sanitation Program (WSP)'s responsibility of the relays is to reach out change promotions. Global Scaling Up Handwashing Project to the households and convince mothers has been implemented by local and to set up designated areas for hand- · Preliminary observations indicate that national governments in Peru, Senegal, washing (i.e., handwashing stations) to men are interested in handwashing Tanzania, and Vietnam, with technical provide convenient access to soap and promotion because of its potential support from WSP.1 The target popula- water when and where needed. impact on their children's health and tion for the project in Senegal includes well being. an estimated 1.5 million women, PROBLEM STATEMENT caretakers, and children living in eighty early on in project planning, women localities in the regions of Dakar, were identified as the target audience Diourbel, Fatick, Kaolack, Louga, Thiès, because of their central role in caring Ziguinchor, and Saint-Louis. for the family--especially children-- and because women's hygiene behav- A central component of the handwash- iors are strongly correlated to reduc- ing project is the planning and imple- ing or transmitting fecal contamination mentation of an integrated communi- within the household. cations program that includes mass media at national and local levels and However, in Senegal, men are typically community promotional events--led heads of household, and in this role by private firms skilled in experiential they exert influence on many levels. For marketing and advertising. In addition, example, when relays initiate a request interpersonal communications at the to make a household visit, their point of household level is handled by fieldwork- contact is the male head of household. ers (called relays in Senegal) who have men also allocate financial resources previously worked on other public health to purchase household items such issues such as family planning, nutrition, as soap, a handwashing station, or 1 The Global Scaling Up Handwashing Project builds on work by the global Public-Private Partnership for Handwashing with Soap (PPPHW), of which WSP is a member. For more information, see www.globalhandwashing.org www.wsp.org 2 Involving Men in Handwashing Behavior Change Interventions in Senegal Global Scaling Up Handwashing Project Project Regions in Senegal for mass media, direct consumer contact, and interpersonal IBRD 37760 communications, an emerging lesson was that the project MAY 2010 PROJECT REGIONS NATIONAL CAPITAL team needed to consider the role of Senegalese men as REGION BOUNDARIES heads of household, with the potential for adding men as a INTERNATIONAL SAINT-LOUIS BOUNDARIES target audience for project implementation. ACTION LOUGA The project team organized a half-day learning event in M A TA M DAKAR THIÈS December 2009, in Dakar, to validate the hypothesis re- DIOURBEL DAKAR garding the role of men and to formulate strategies to more FATICK effectively involve men. The event was attended by 25 peo- KAOLACK TAMBACOUNDA ple from ten local organizations responsible for supervising ATLANTIC OCEAN the relays. Using an emergent Learning map3, participants addressed the following questions: KOLDA SÉDHIOU KÉDOUGOU ZIGUINCHOR a. What did you learn about the importance of involving men in handwashing promotion and what makes you believe this? b. Based on your experience, what are the best strategies dispenser. Indeed, in a 2009 survey of Senegalese women, to involve men in handwashing promotion? Why do you nearly half of those surveyed (48 percent) indicated that men recommend these strategies? provide soap for the household.2 c. Within your current programs, what are the opportunities to integrate the strategies you propose? operating within this social context, relays reported that, during many household visits, men expressed frustration at not being KEY LEARNINGS included in the handwashing promotion discussion. In other The Dakar event produced several key learnings: instances, men took action to help facilitate the discussion: · As heads of household, Senegalese men play several key roles. Based on field observations and discussion, three One day I came in a polygamist['s] household. It was dif- key roles were identified--gatekeepers, protectors, and ficult to get all the women's attention at the same time. role models--and ways to leverage these roles were dis- The wives were not keen to sit together. When the hus- cussed (Figure 1). band heard my introduction, he joined us and required · In these roles, men can allow or deny access to new all women to stop their occupations and attend the dis- information and necessary resources (e.g., soap, hand- cussion. Our handwashing messages were reinforced washing station). They can enable, reinforce, and sustain by him and he committed himself to provide the neces- behavior change. sary products for handwashing and to monitor the family · When men are engaged early on in the discussion they are members' behavior. more likely to take an active role to mobilize family mem- bers, reinforce messages, and make the household avail- --Relay report from a household visit in a suburb of able to receive handwashing with soap messages. Dakar · Though women remain a critically important target audi- ence for handwashing promotion, men should also be Thus, while the Global Scaling Up Handwashing Project had included as a target audience for mass media, direct con- initially focused on Senegalese women as the target audience sumer contact, and interpersonal communications. 2 Kane, m. 2009. rapport etude lavage des mains au savon Senegal. Unpublished study, Water and Sanitation Program, World Bank. 3 For more on the emergent Learning map, see Global Learning Strategy by Christiane Frischmuth, available at www.wsp.org/scalinguphandwashing. www.wsp.org Global Scaling Up Handwashing Project Involving Men in Handwashing Behavior Change Interventions in Senegal 3 Figure 1: Leveraging the Role of Men in Handwashing Based on outcomes of the learning event, the team took sev- Promotion eral steps to adjust the intervention: Step 1: modify the training manual for relays and integrate through planned supervision and refresher trainings. Role Model · Practices handwashing with Step 2: Adjust communication materials (e.g., logo, bill- soap himself boards, television and radio spots) to increase the visibility Protector of men's role and strengthen their commitment to support · Ensures that soap and water are handwashing with soap in the household. available and used at critical times (follow-up role) The billboards in Illustration 1 show the adjustment made in Gatekeeper visual materials targeting the public. The billboard created ear- · Allows access to his household to outreach workers and participates lier in the project targeted women (left), and shows a woman in session in the foreground washing her hands. Her husband and chil- · Provides funds for soap for handwashing and any device dren are pictured in the background. The caption emphasizes the woman's role in handwashing behavior change: "I commit myself to get my family to adopt handwashing behavior." as gatekeepers, men allow access to their household and A subsequent billboard (right) illustrates the decision to in- provide funds for soap. as protectors, men can play a follow-up role to the outreach session and ensure that household clude men in the media campaign. Here, a couple express a members wash their hands with soap. as role models, men joint commitment: "We commit ourselves more than ever to wash their hands with soap while encouraging others to do get our family to adopt handwashing behavior." the same. Starting with gatekeeper, the level of effort required increases at each level. Step 3: During focus groups with women, fieldworkers will identify the households in which husbands have been Illustration 1: Adjusting Communication Materials to Emphasize Men's Role a billboard produced to promote handwashing with soap was initially designed to target women (left). recognizing the impor- tance of men as heads of household, a later iteration (right) features a husband and wife. www.wsp.org 4 Involving Men in Handwashing Behavior Change Interventions in Senegal Global Scaling Up Handwashing Project exposed to handwashing messages during household visits and will try to managers should consider these ques- tions and others as they develop current About the project Global Scaling Up Handwashing is collect information about changes in and future handwashing programs. a WSP project focused on learning men's attitudes or behavior with regard how to apply innovative promotional to handwashing within the household. --By Seydou nourou Koita approaches to behavior change to generate widespread and sustained Step 4: Adjust the monitoring tools to improvements in handwashing ensure effective and systematic captur- with soap at scale among women ing of men's participation. of reproductive age (ages 15­49) WHAT ELSE DO WE NEED Acknowledgements and primary school-aged children (ages 5­9). The project is being TO KNOW? The author wishes to thank the Global implemented by local and national As the team works to adjust the interven- Scaling Up Handwashing Project team, governments with technical support tion by modifying training and communi- especially Hnin Hnin Pyne, Alfred Dacosta, from WSP. To learn more, visit cation materials and adjusting monitoring Yolande Coombes, Jacqueline Devine, www.wsp.org/scalinguphandwashing. tools, several questions emerge, includ- Libasse Diagne, Amy Grossman, momar ing: What is the most powerful motivator Kane, mamadou Lamine mbengue, Contact us to engage men to support handwash- Bernard Sene, mamadou Thiam; and For more information, please ing behavior change in their house- our implementing partners and their visit www.wsp.org or email hold? Does the inclusion of men have field staff, including APAPS, eDe, eXP Seydou Nourou Koita at a catalyzing, neutral, or negative impact momentum, Hors media Communica- wspaf@worldbank.org on women's attitudes towards hand- tion, mediacom, and SenAGroSoL, washing behavior change? Program for their valuable inputs. The Water and Sanitation Program (WSP) is a multi-donor partnership created in 1978 and administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. WSP's donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill & melinda Gates Foundation, Ireland, Luxembourg, netherlands, norway, Sweden, Switzerland, United Kingdom, United States, and the World Bank. WSP reports are published to communicate the results of WSP's work to the development community. The map was produced by the map Design Unit of the World Bank. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of the World Bank Group concerning the legal status of any territory or the endorsement or acceptance of such boundaries. © 2010 Water and Sanitation Programs (WSP) www.wsp.org