UNICEF
Minimum Operating Requirements for Hygiene Promotion in
Emergencies and Regular Programs
For Pakistan Country Program 2011
Why Minimum Requirements for Hygiene Promotion in Emergencies?
During emergencies Hygiene Promotion (HP) has been given low attention than it deserves. While
water is a life-saving commodity in emergencies, its safety and reduction of contamination is essential to
avoid disease outbreaks. This is only achievable with intensive HP within the affected community. In
many cases there is the tendency to act quickly to save lives and some essential components such as
HP are left unattended.
Faecal Oral Transmission of diseases is 80% likely to happen during emergencies due to the
compromised living conditions e.g. congestion, inadequate hygiene facilities, shortage of water and
storage containers, limited knowledge on hygiene practices and apathy.
HP in emergencies has been made synonymous to distribution of hygiene kits. While these are
important there are a number of other important activities to be conducted in emergencies. The aim is
to reduce and control WASH related diseases such as diarrhoea/cholera and save lives.
These minimum requirements are therefore important to ensure the following;
1. A clear understanding of the importance of HP in emergencies
2. To guide UNICEF and partners on how to conduct HP in emergencies
3. The importance of monitoring HP
4. How to engage communities and promote pride and dignity in emergencies
Who are these Minimum Requirements for?
The WASH Program must adhere to these minimum requirements for effective and consistent high
impact HP interventions in emergencies.
 UNICEF WASH Officers - should use MR-HP as a constant reference when implementing activities
on a day-to-day basis. They can be used for planning and designing HP activities in emergencies.
 Staff from UNICEF Partners – must adhere to the MRs in every intervention and must refer to them
when writing their proposals. Field staff will be trained on the MRs and how they should be
implemented. This is the obligation of UNICEF WASH Staff.
 Chief WASH & Country Management Teams should use MR-WASH as a checklist of “must dos”
to be fulfilled by staff and partners.
Guide to Using the Document
MR-HP is presented as follows:
1. A ‘checklist’ of the MR-HP in emergencies with a focus on 3 key priorities – hand washing with
soap, safe excreta disposal and safe water (household water treatment).
2. References to global standards e.g. SPHERE
3. Innovative approaches to WASH activities that meet these MR are encouraged, these are just a
guide.
4. All staff will be held accountable for deviating from the MRs. It is expected that in some instances,
some requirements may not apply, hence, the staff member will provide a justification for other for
using other ways.
Description
Minimum
Requirement
Ways of Working for
Hygiene Promotion Teams
 HP activities must be planned with other WASH officers (Sanitation and Water) in respective field offices
 When selecting an implementing partner, give attention to existing capacity to deliver HP in emergencies. Where the partner may need
to recruit, UNICEF WASH Officers must support in the recruitment (interviews) of suitable candidates (see minimum requirements of a
HP field officer)
 It is important that WASH officers have a basic understanding of supply and logistics and how they work in emergencies in order to
ensure HP supplies requested are received on time.
It is expected that WASH staff on surge adhere to the guidance of the existing team to avoid introducing already existing activities.
Co-ordination
 All UNICEF WASH and Partners’ staff must attend WASH Cluster co-ordination meetings and represent and advocate for community
needs to be met at the earliest and most effective way possible. Report gaps and challenges to implement projects and propose
solution. UNICEF should strive to be the lead agency for the HP/social mobilization taskforces given its expertise in the area.
Assessment, Knowledge,
Attitude and Practices
Study/Baseline
 Before any HP intervention, a WASH priority risks and needs assessment must be conducted. HP issues should be prominently
represented. The Global WASH Cluster Assessment Tools or other tools can be used.
 A baseline survey on Knowledge, Attitude and Practices of the people as relates to WASH must be conducted at the beginning of every
project. These will form the basis of the monitoring indicators.
Forward thinking for HP –
post emergencies
 Consider providing communities with strong behaviour change messages that will be effective post disaster. For displaced communities
provide them with a ‘returnees’ kit when they return to their homes of origin. For example, enough soap to last a family next 3 months,
narrow necked containers for water storage, packets of water treatment tablets/s, and laminated posters and fliers for use in their homes
Reporting
August 2011
 There should be a clear, concise mechanism for collecting and reporting information about the progress of a WASH programme. A simple
reporting format should be provided to partner hygiene promotion officers. Reporting should not be strenuous to staff; collect information that
is necessary and useful. For HP it is important to know number of people reached with messages, number of people benefiting from hygiene
kits, number of children involved in hygiene club activities, number of sessions held, number of training sessions for HPs, number of HPs
trained, among other relevant information.
 Encourage bilateral feedback between UNICEF and partners on field activities, progress, challenges and lessons learnt.
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
Description
Minimum
Requirement
Monitoring, Evaluation and
Learning
 Hygiene Promotion monitoring forms should be provided at the onset of a program, regular monitoring is encouraged to measure progress
and readjust the program where necessary.
 Monitoring indicators should be based on baseline survey findings – see recent baseline surveys (Punjab, KP, Sindh and GB)
 It is important to hold review meetings with partners at least once a month at field level during emergencies and quarterly review post
emergency.
 All lessons learnt should be discussed by partners before sharing with the WASH Cluster. Document lessons learnt and share human interest
stories.
 Health data from local health units should be collected monthly to mark the trend of diarrhoeal/WASH related diseases. More comprehensive
data should be collected from the Health Cluster for analysis
Ensuring the participation
of the most vulnerable
 Ensuring equity is important in Hygiene Promotion. UNICEF and partners should strive to reach the most marginalized and vulnerable poor.
These are more susceptible to diseases given their lack of basic necessities.
 Promote working with Community Based Organization that will reach areas where UNICEF and major partners may not reach.
Convergence
 Hygiene Promotion finds its niche in promoting hand washing with soap, safe excreta disposal and safe water (household water treatment).
These key areas should be promoted in Schools through the Education Section, in Nutrition Centres, in Child Protection centres, during
Mother and Child Week, Sanitation Week, Immunization Campaigns etc.
 Hygiene promoters should work closely with Lady Health Workers for intensive hygiene promotion activities.
 UNICEF C4D should guide WASH officers on common thematic and geographic areas for convergence
August 2011
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
Description
Field Hygiene Promoters
Minimum
Requirement
 Must be trained on Hygiene Promotion key messages and how to communicate them. A minimum of 2 days at the onset of an emergency
and 4 days for regular program. UNICEF must provide the training program requirements to partners designed according to the context of
emergency or issues at hand. (See a proposed training program).
 All Partners must use the same training program to allow a standard follow-up across all areas.
 Hygiene Promotion in Emergencies Training Package developed by Global WASH Cluster is a good resource and should be promoted and
used by all partners. It simple and straight forward. (UNICEF may consider translating it into Urdu)
http://www.humanitarianreform.org/Default.aspx?tabid=343
 Minimum requirement for a field hygiene promotion officer is a basic degree/college diploma, speaks English (essential for reporting), comes
from the same area of operation, speaks local language, and is passionate to the mission of UNICEF – improve the lives of women and
children of Pakistan.
 2 hygiene promoters per 100 households (or See SPHERE requirement).
Distribution of Hygiene
Kits
 Where distribution is not en masse, it should be done in consultation with local authorities and communities in order to identify the most
vulnerable groups (inclusion of poor and vulnerable is key to equitable distribution).
Composition of Hygiene
Kits
 While the kit will depend on the requirements in an emergency, the bare minimum should be as follows and as per the SPHERE Standards
1. Soap for washing clothes, bathing, hand washing (preferably with disinfectant)
2. Container with long handle for fetching water from storage container
3. Sanitary towel for women (absorbent cloth)
4. Jerrycans for fetching water (discourage distribution of buckets in emergencies as they promote recontamination of water in the
household).
5. Laminated hygiene promotion fliers with clear messages on hand washing with soap, safe excreta disposal and safe water.
6. PUR sachets and or aquatabs
7. ORS Sachets MUST not be part of a hygiene kit as they are normally confused with the PUR sachets and other water treatment
tablets
8. Other items – combs, toothpaste, towels, toothbrushes, nail cutters, etc as seen appropriate.
August 2011
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
Description
Minimum
Requirement
Contingency Planning
 WASH must have the following in stock for a minimum of 20,000 people to respond to emergency;
1. Laminated Hygiene promotion posters, fliers, booklets, for messaging
2. Hygiene kits (see kit composition)
3. ORS sachets
4. Water treatment tablets (PUR sachets and Aquatabs)
5. Training manual for hygiene promoters (500pieces)
Hygiene Promotion in
Schools
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Database for Hygiene
Promotion
 Important to maintain a data base for all trained hygiene promoters, number of training days, number of community hygiene clubs formed,
number of hygiene committees formed and active, number of Lady Health Workers active in the area, number of teachers trained, number of
hygiene clubs in schools and all other relevant data.
 Important also to map the areas that are covered by hygiene promoters and their population, in order to identify any gaps and fill them.
August 2011
Teachers must be trained at least for 2 days on hygiene promotion methodologies in schools
Hygiene promoting schools must be supplied constantly with soap, must have well established hand washing facilities,
Simple hygiene booklets with hygiene messages to be given to children
Establish hygiene clubs in schools and engage children as behaviour change agents.
Frequent visits by field hygiene promoters for monitoring purposes should be done at least a month
Provide play items for children to encourage hygiene promotion activities – prizes may also be given where applicable
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
Development and Use of
Information, Education
and Communication
materials
August 2011
 Development and use of IEC should also be undertaken in close collaboration with the WASH Cluster and appropriate government
departments to ensure that consistent, ‘approved’ messages are used.
 ALL materials must also be endorsed by the relevant ministry e.g. Ministry of Health at the level it exists or in early recovery National
Disaster Management Authority.
 All HP promotion materials developed must be done in consultation with Partners, the WASH Cluster HP task force/technical working
groups and with UNICEF C4D specialist in the respective offices
 No materials should be developed without the endorsement of the HP working group
 All existing materials should be kept within easy access by all staff to avoid developing new ones
 There should a minimum stock of laminated printed IEC materials for use in emergencies to reach at least 20,000 people
 At the onset of an emergency, WASH staff should act fast enough to reach as many people as possible. While print material is easy to
distribute, it should be informed by literacy levels or should be distributed through schools.
 Consider a wide range of IEC materials to reach high numbers of beneficiaries
 Consider children as strong agents of change and involve them accordingly.
 After the onset of emergency, there should be a significant reduction of print materials and a stronger focus on interpersonal
communication through volunteers, field hygiene promoters, Lady Health Workers and Schools among other organized groups.
 Imams or religious leaders play an important role in disseminating health and hygiene messages and making them credible. Partners are
encouraged to make use of this opportunity as much as possible.
 Use of folk media cannot be overemphasized – drama, folk songs, poems, stories etc, are inexpensive yet effective ways of disseminating
health messages
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
Cholera and other
Diarrhoeal Outbreak
Control
 All staff must know the measures to take for prevention and control of cholera
 In case of a major cholera or acute watery diarrhoea outbreak (AWD), WASH staff should work under the guidance of WHO as the lead
agency mandated for the management of epidemics.
 Should Cholera or AWD outbreak occur the WASH team and partners must ensure the following MRs
o Intensive Hygiene Promotion focusing on hand washing, excreta disposal and safe water
o Chlorination of all drinking water.
o Provision/distribution of ORS and teaching people the importance of rehydration. Demonstrate how to make SSS at home
o Hygiene Promoters should be trained on key symptoms of cholera vs normal diarrhoea, quick remedies at home and promoting
early treatment seeking behaviour. (delays in recognizing the symptoms, delay in rehydration and delay in treatment are the 3
causes of cholera deaths).
o Provision of hygiene promotion at cholera treatment centres and clinics
What Hygiene Promotion
is NOT
 Field Hygiene Promoters must refrain from prescribing drugs for minor illnesses
 UNICEF Focuses on 3 key areas for HP – hand washing with soap, safe excreta disposal and safe water. Any other topics beyond these
become broader health education e.g. malaria, HIV and AIDS prevention, TB etc.
 IEC materials for WASH should therefore focus on those key areas
Exit from Hygiene
Promotion Programmes
 UNICEF and partners should initiate community health/hygiene clubs, school hygiene clubs and teacher training to ensure
sustainability/continuation of the activities
 Building the capacity of local Community based organization will ensure continuity of the program long after UNICEF and major partners
leave the area of operation.
 An assessment must be conducted before exit to determine community needs. There should be a clear justification to exit.
 An exit strategy should be discussed with partners and authorities and shared with all staff.
All UNICEF partners are encouraged to adhere to these minimum requirements and include most if not all of them in their Contract Agreements. These MRs must be used
alongside SPHERE and other global and national guidelines.
Prepared by Penninah Mathenge
WASH Specialist – Hygiene Promotion
Pakistan
August 2011
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
Approved by
Chief of WASH
Pakistan
Hygiene Promotion Orientation Session for Hygiene Promoters/Community Mobilizers.
HP- Hygiene Promotion , HPs- Hygiene Promoters, Q&A – Question and Answers
Session
Aim
Introductions
To break the ice. HPs will come in anxious of what is expected
of them, less confident, and shy.
Participants Expectation
Pretest
Objectives of the orientation
session
Definition of terms
Key Messages for hygiene
promotion:
Gauge the understanding of participants on simple WASH
issues
Understand the key areas to be covered during the training.
Clarity of meaning
To focus on key areas for HP:
Parameters defined as: Safe water (Source, transportation,
household treatment, storage and use)
Sanitation: safe disposal of excreta
Hygiene: Hand washing at critical times
Pakistan 2011.
Methodology
Fun introductions that will make everyone at ease. E.g. Participants will
introduce each other - Name, place of origin
Participants wrote their expectations on coloured paper, posted on the
wall, then categorised according to common expectations/themes
A written test
Presentation
Q&A
What is hygiene promotion?
What is the difference between hygiene promotion and health
education?
What is the meaning of emergency?
What are participatory methodologies?
Behaviour Change Communication
3 groups: Water, Sanitation and Hygiene.
Group Water: in 5 min to define safe and unsafe water sources, how
they think water is contaminated and how it can be treated at
household level
Sanitation: Open defecation is common in many villages in Pakistan,
is it dangerous and why? What can we do about it? 5min
Hygiene: Which are the critical times to wash hands. What can people
use instead of soap. 5mins
August 2011
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
How to conduct hygiene
promotion
To understand steps and methodologies of hygiene promotion
Understand reach vs effectiveness
Group work
Discuss and list ways of communicating/passing messages in your
localities.
Methodologies: Mass communication vs Interpersonal communication.
5 min debate on what the two means of communication
At the onset of an emergency, the emphasis is on reach to raise
awareness on a subject, while at the same time being effective. More
effective programs for behaviour change are created at a later phase of
the emergency.
Community organization for
Hygiene Promotion
Available Materials for use in
hygiene promotion
August 2011
To understand the various levels and existing structures,
settings, environment relevant for HP
Deepen HPs confidence in using the materials
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a. Discuss mass communication methodologies
b. Discuss interpersonal methodologies:
c. Group work: 1 group comes up with a role play on a
dehydrated child and what to do?, 1 group composes a song
on hand washing, another group a poem, another group visits
a household. These practicals build the HPs confidence on
how to do the exact activities with the community.
Discussion
Community Mapping
1. Show the HPs posters, fliers and leaflets.
2. Discuss the 3 pile sorting cards
3. Use of loud speakers
4. Demonstrations: a hand washing with soap demonstration.
(HP to practice talking to the community on importance of
hand washing with soap as he/she washes hands correctly).
5. F-diagram; Transmission route
Minimum Requirements for Hygiene Promotion – Pakistan Country Office
Hygiene Kits
Show the participants the hygiene kits components.
They must inform the beneficiaries what each item is and how it should
be used. They should demonstrate their use.
Dangers of dehydration
Create understanding of dangers of dehydration
HPs in their work will be coming across children who are suffering from
diarrhoea and at risk of dehydration. They should be able to know the
symptoms and act swiftly. Discuss symptoms
Involving children in hygiene
promotion
How to conduct oneself as a
HP in the community: Roles
and Responsibilities of a HP
To give children a chance to participate in hygiene promotion.
To recognize children as agents of behaviour change
Understand how respect cultures, patience, and demonstrate
confidence and knowledge
Lesson Plans and Reports
How to plan lessons and report activities
Monitoring
Purpose of checking on progress
How to rehydrate using a home-made salt sugar solution
August 2011
Role play:
This should be based on formative research on common practices,
common diseases e.g. if diarrhoea is common, lessons should be
planned around preventive measures. Provide a simple sheet
indicating subject, methodology, target group, activities.
Report should be kept simple, indicating the above plus numbers
reached.
This can be done during the session if time allows or on-job training.
Provide monitoring forms
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
Exit strategy
Sustainability of hygiene promotion projects
Q&A
Clarify any fears from the participants
Close
Top Tip to a successful hygiene promotion session: Keep It Short and Simple!
Discussion
Ask them questions to gauge their understanding
Exit Strategy
Ensure a solid community organization and involvement in the current program: Formation of Hygiene Clubs, Hygiene Committees, Religious Leaders, School Hygiene
Committees.
Train the committees on the usefulness of hygiene promotion in the community
Discuss long term goals and plans with the committee
Feedback to the communities and committees the progress of all activities: this will make them feel involved and will create a sense of ownership of the projects
Ensure that committees understand their role in hygiene promotion and that they see and hear the changes the projects have made in the community e.g. hand washing
practices and reduction of diarrhoea.
Involve children with activities that will keep them active even when the project is completed
Identify ‘natural’ helpers who are community activists and instil in them the passion for hygiene promotion.
On a more organized structure: Form committees that have religious leaders, school heads, women activists, lady health workers/local hygiene promoters, administrative
leaders and youth to steer the projects/activities even after project end.
A hand-over ceremony is a good way to publicly solicit for continuity. A respected leader could be asked to make the declaration that communities will continue with the
projects.
‘Weaning off’ communities is important, ensure a gradual process than cutting off the projects immediately. Where possible, revisit the projects for support and emphasis of
the importance of continuity.
August 2011
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office
This is a very important tool for hygiene promotion. It generates discussions on transmission routes, blocking the routes and how communities can find solutions to protect
their own health.
 Identification of applicable tools consistent with the principles of community participation is important in effective sanitation, hygiene and behavioral change promotion.
The methodological approach of the F-Diagram in explaining the fecal-oral transmission route has helped in the understanding of the effects of open defecation on
water sources, food, health and well-being. It also motivated the actions to be taken to solve these problems.
August 2011
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office

The process and approach to identifying community development problems are very important and central to encouraging community participation and the resultant
program sustainability. Through the careful and well-chosen process and approach to hygiene and sanitation promotion, communities will be able to understand the
consequences of open defecation and the need to own and use household latrines, have safe drinking water sources like boreholes, and contribute to the repair and
maintenance of water and sanitation facilities, and of course will understand the importance of hand washing with soap.

In many villages (even during the workshop when participants were asked what they call feaces in their local language), issues about sanitation and hygiene,
especially feces, are not normally discussed openly due to cultural reasons. People shy away from this topic. Participants during the workshop, were shy to
pronounce feaces in their local language. However, the use of the F-Diagram tool breaks down these socio-cultural barriers, making the F-Diagram an effective tool
in initiating and sustaining discussion on sensitive yet important development issues and eliciting significant response from all social groups in a community.

The F-Diagram characterized by colorful visual representations is attractive to children as they participated equally in the discussion on the effects of open defecation
and poor sanitary practices. This is very important because behaviors that these children learn at an early age are internalized and reflected in their actions later in
life. They are also likely to pass on these behaviors to their peers, families and their offspring.
Make use of this and other tools! They are effective with rural communities for reduction of diarrhoea.
August 2011
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Minimum Requirements for Hygiene Promotion – Pakistan Country Office