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16 December, 2019 00:00 00 AM / LAST MODIFIED: 16 December, 2019 12:27:21 AM

WHO on hygiene education

WHO on hygiene education

Scope of hygiene education

Community-based surveillance

Effective and sustainable programmes for the surveillance of water supplies re- quire the active support of local communities, which should be involved at all stages in such programmes, including initial surveys; monitoring and surveillance of water supplies; reporting faults, carrying out maintenance, and taking remedial action; and supportive actions including sanitation and hygiene practices.

This will involve setting up a comprehensive educational programme to ensure that the community:

Table 7.1 Behaviours to be recommended in hygiene education

Water source:

All children, women, and men in the community should use safe water sources for drinking and food preparation.

Adequate water should be used for hygiene purposes such as bathing, household cleanliness, and clothes washing.

Water should be efficiently used and not wasted. Wastewater should be properly drained away.

Improved water sources should be used hygienically and be well maintained.

There should be no risk of contamination of water sources from nearby latrines, wastewater drainage, cattle, or agricultural chemicals.

Water treatment:

Simple purification procedures, e.g. chlorination, should be carried out on the water source if necessary.

If necessary, water should be filtered to remove any solid material, guinea worm, etc. (see section 6.7.1).

Water collection:

Drinking-water should be collected in clean vessels without coming into contact with hands and other materials.

Water should be transported in a covered container.

Water storage:

Water should be stored in vessels that are covered and regularly cleaned.

Drinking-water should be stored in a separate container from other domestic water wherever possible.

Water drinking:

Drinking-water should be taken from the storage vessel in such a way that hands, cups, or other objects cannot contaminate the water.

Water use:

Adequate amounts of water should be available and used for personal and domestic hygiene. (It is estimated that a minimum of 30–40 litres per person per day are needed for personal and domestic hygiene.)

Food handling:

Hands should be washed with soap or ash before food is prepared or eaten.

Vegetables and fruits should be washed with safe water, and food should be properly covered.

Utensils used for food preparation and cooking should be washed with safe water as soon as possible after use and left in a clean place.

Excreta disposal:

All men, women, and children should use latrines at home, at work, and at school.

The stools of infants and young children should be safely disposed of.

Household latrines should be sited in such a way that the pit contents cannot enter water sources or the groundwater table.

Hand-washing facilities and soap or ash should be available, and hands should always be washed after defecation and after helping babies and small children.

Wastewater disposal:

Household wastewater should be disposed of or reused properly. Measures should be taken to ensure that wastewater is not allowed to create breeding places for mosquitos and other disease vectors or to contaminate safe water.

is aware of the importance of water quality and its relation to health, and of the need for safe water supplies;

accepts the importance of surveillance and the need for a community response;

understands and is prepared to play its role in the surveillance process;

has the necessary skills to perform that role.

Hygiene behaviours

The provision of a good drinking-water supply alone is insufficient to ensure health. There are many stages in the collection, storage, and handling of food, the disposal of excreta, and the care of children at which drinking-water can become contaminated and the community exposed to pathogens in excreta.

Children, especially those under 5 years of age, are particularly vulnerable to diarrhoea. A common belief is that children’s faeces are harmless, whereas in fact they are the main source of infection of other children.

Parents may not hygieni- cally dispose of their young children’s faeces, young children may not use latrines, and the yards surrounding homes are often contaminated.

There are many transmission routes for water-related and sanitation-related diseases, and hygiene education can therefore cover a wide range of actions. The most important behaviours from the point of view of health will depend on the community, the disease pattern, and the climate.

One of the functions of the initial field inspection and surveillance is to determine which behaviours the hygiene educational programme should seek to promote in the community (Table 7.1).


Planning hygiene education

Planning hygiene education in a community involves the following steps:

dialogue with the community and local agencies;

selection of priority hygiene behaviours to be changed, based on surveil- lance data and felt needs within the community;

analysis of influence on selected behaviours and the implications for hygiene education.

Preparation of an action plan for hygiene education requires answers to the following questions:

How will community participation be mobilized?

Who should the education be directed at (target group)?

What should the content of the education be?

Who should carry out the hygiene education?

What educational methods should be used?

What support should be provided by the surveillance agency?


Community participation and empowerment

The importance of community participation has been stressed in earlier chapters. Hygiene behaviours are particularly difficult to change because they relate to daily activities, they are shared by the whole community, and they form part of the culture and traditions of the community.

The improvement of water supply, sanitation, and hygiene should be seen as part of an overall process of community development. It is important, therefore, to work with the whole community and particularly with schoolchildren, and to involve them in all stages of hygiene education, including selecting priority hygiene behaviours, understanding the influences on such behaviours, selecting educational methods, and implementa- tion. The educational methods used should be those that strengthen and em- power individuals and communities to work for change.

There are no set rules for developing a community participation programme, but the stages described in Table 7.2 are common to many such programmes.

The community may already be highly organized and taking action on health issues. If so, only a few visits by surveillance field staff will be needed to introduce the concepts of surveillance and involve the community in the surveillance programme. However, it may be that there is no well developed structure, that sections of the community, such as women, are poorly represented, and that there are disagreements or factional conflicts.

In this situation, achieving community participation will take more time and require many visits by field staff to bring people together, resolve differences, agree on common aims, and take action. Even after the community starts to become involved, further visits, possibly over several years, will be needed to provide support and encouragement, and ensure that the structures created continue to operate.

Selection of behaviours to be changed

It is better to concentrate on a small number of behaviours than to attempt to influence all the hygiene behaviours listed in Table 7.1. The behaviours chosen should be selected on the basis of probable public health benefit to the commu- nity. Some of the questions that will need to be asked in order to determine priorities include the following:

What is the evidence that the behaviour represents a problem in the commu- nity?

Which behaviour changes will have the greatest impact on improving health?

Which hygiene behaviours will be the easiest to change?

What are the specific requirements of the water-supply and sanitation sys- tems that are being promoted in the community?

What are the felt needs and priorities of the community?

It is best to concentrate on those hygiene practices shown by the surveillance to be a priority for remedial action in the community concerned; these should be the practices which are likely to be of the greatest benefit to health. However, greater efforts will be required to change hygiene practices that the community does not see as important or that conflict with its culture and traditions.

Factors influencing hygiene behaviour and selection of content of education

Hygiene education programmes should be based on an understanding of the factors that influence behaviour at the community level. These might include:

enabling factors such as money, materials, and time to carry out the behaviour;

Table 7.2 Stages in the community participation process


Getting to know the community:
learning about the community, its structure and leadership pattern
initial contacts with families, leaders and community groups
dialogue and discussion on concerns and felt needs

Organization building:
strengthening of community organization
establishment of new structures, e.g. water committees, women’s groups
educational activities within community structures
decision-making on priorities
selection of community members for training as water leaders

Initial actions:
action by the community on achievable short-term goals that meet felt needs and bring the community together
reflection on initial activities
setting of priorities for future activities

Further actions:
activities in which the community takes a greater share of responsibility for decision- making and management


pressure from particular members of the family and community, e.g. elders, traditional healers, opinion leaders;

beliefs and attitudes among community members with respect to the hygiene behaviour, and especially the perceived benefits and disadvan- tages of taking action, and the understanding of the relationship between health and hygiene.

An understanding of the factors that influence hygiene behaviours will help in identifying the resources (e.g. soap, storage containers), the key individuals in the home and community, and the important beliefs that should be taken into account. This will help to ensure that the content of the hygiene education is relevant to the community. Good advice should:

result in improved health

be affordable

require a minimum of effort and time to put into practice

be realistic

be culturally acceptable

meet a felt need

be easy to understand.

One of the most important characteristics of effective health education is that it builds on concepts, ideas, and practices that people already have. Most commu- nities already have beliefs about cleanliness, diarrhoea, and hygiene. In the short term, it may not be necessary to convince people of the correctness of the germ theory of disease in order to get them to use latrines and practise good hygiene.

This is a long-term objective that is best achieved in schools. It is possible to find supporting ideas in many traditional belief systems, and to appeal, for example, to the desire for comfort and privacy.

Information needs for hygiene education

Before a formal hygiene education programme is begun, it is important to include in the sanitary survey an assessment of the sociocultural factors that characterize the community, in order to determine:

local beliefs and attitudes regarding water, sanitation, and health;

traditional water use and defecation habits and excreta disposal practices;

current levels of knowledge about disease transmission, especially among community leaders and other influential individuals;

the priority given to improvements in water supply and sanitation in relation to other community needs;

existing channels of communication in the community including books, newspapers, and magazines, radio or television, traditional drama, songs, and story-telling;

the members of the community and field workers from other agencies who might be involved in hygiene education activities.




Table 7.3 Characteristics of effective health education

Promotes actions that are realistic and feasible within the constraints faced by the community

Builds on ideas and concepts that people already have and on common practices

Is repeated and reinforced over time using different methods

Uses existing channels of communication, e.g. songs, drama, and story-telling, and can be appropriately adapted to these media

Is entertaining and attracts the community’s attention

Uses clear simple language and local expressions, and emphasizes the short-term benefits of action

Provides opportunities for dialogue and discussion to allow learner participation and feedback

Uses demonstrations to show the benefits of adopting the practices recommended



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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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