Hygiene Promotion Strategy (draft)

Cholera Response Haiti

December 2010

Hygiene Promotion sub-Cluster

Table of contents
1. Introduction
2. Goal and objectives
3. Hygiene Promotion sub-Cluster priority areas
4. Hygiene promotion methods and approaches
4.1 Priority hygiene areas for cholera response
4.2 Hygiene promotion in earthquake affected areas
4.3 Hygiene promotion in non-earthquake affected areas
4.4 Stigmatisation of cholera affected persons
4.5 Training of community mobilisers
4.6 Communication channels for promoting hygiene
5. Enabling factors for HP
6. Monitoring
7. Coordination
Annexes
Annex 1: Table of HP activities
Annex 2: Goal, objective, effects and outputs and indicators
Annex 3: Terminologies and definitions
Annex 4: Essential skills and knowledge required by facilitators
Annex 5: HP contexts and proposed channels of communication
Annex 6: Responsibilities and accountabilities matrix
Annex 7: Glossary of terms

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1.

Introduction

Gaps identified during monitoring and assessment activities have necessitated a review of the hygiene promotion (hereafter
HP) strategy developed in November. The revision seeks to improve coordination among HP partners by providing a guiding
framework and standards for HP approaches and methods in earthquake and non-earthquake affected areas. The strategy
also sets forth principles for enhancing coordination with both WASH and non-WASH stakeholders.

2.

Goal and objectives of HP activities

The goal of cholera response HP activities is to reduce mortality, transmission and impact of the cholera epidemic. The
specific objective is to ensure children, women and men are aware of the cholera health risks and are mobilised and enabled
to take action, to prevent or mitigate outbreak risks by adhering to safe hygiene practices.
A table outlining the goal, objective, effects, outputs and indicators is attached as Annex 2.

3.

HP sub-Cluster priority areas

Non-earthquake affected areas should be prioritised as there is limited or no WASH actor presence or programmes (exception
is Artibonite). The North East, Grande Anse, Nippe and Sud Departments should be prioritised for all HP and mobilisation
activities. Earthquake affected areas generally have WASH or other actor presence. In addition to non-earthquake affected
areas, HP activities should also prioritise earthquake affected areas where there has been no WASH or other actor present.
The following indicators should guide HP interventions:
o
o
o
o

Areas with reported and confirmed cases or neighbouring areas with reported cholera cases.
Areas with that rely on surface water or water from shallow unprotected wells.
Low lying areas (eg along rivers) that are subject to flooding, and with low water and sanitation coverage
High population density areas with low water and sanitation coverage and poor hygiene (eg. slums, IDP camps,
markets, bus stations)

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4.

Areas that are difficult to access due to geophysical conditions, having limited access to mass media and are far
from existing treatment centres/units and ORS posts

HP methods and approaches

Hygiene promotion principles

1. In view of conflicting definitions of the various activities being carried out across different Clusters, a definition of hygiene
promotion and underlying principles is presented for clarity.
2. Hygiene promotion refers to a range of approaches that systematically seek to stimulate and facilitate people to
practice water and sanitation - related hygiene behaviours, by building on what people know, do and want.
3. HP provides a practical way to facilitate community participation and accountability in emergencies. It starts with
systematic data collection to find out and understand what different groups of people know about hygiene, what they do,
what they want and why this is so.
4. Understanding what people know, do and what physical, social, cultural or economic constraints influence their behaviour
requires competency in participatory methodologies eg. transect walks, history line, focus group discussions. HP
facilitators should be trained in participatory methodologies.
5. Information obtained is used to set objectives and to identify and implement activities that enable the different groups to
measurably reduce risky conditions and practices and to strengthen positive situations and behaviours.
6. Unlike educational methods, which seek to impart knowledge, the focus of promotion is to change behaviour while taking
into account that people are not empty vessels.
The difference between health campaigns and hygiene promotion is:
health campaigns are top-down communication and educational activities that mainly address the link between good
hygiene and better health
Hygiene promotion is a bottom-up approach based on evidence that providing information on health (knowledge)
alone is not sufficient to change peoples practices. Privacy, convenience, dignity, security, disgust, peer pressure and
livelihoods are key motivational factors for behaviour change
Hygiene/health education may be part of this methodology; however, hygiene promotion includes additional elements
Hygiene promotion builds upon the knowledge, behaviour and beliefs that people already have
Emphasis of hygiene promotion is on enabling people to take ACTION to mitigate health risks (by adhering to safe
hygiene practices) rather than simply raising awareness about the causes of ill health
Hygiene Promotion also involves ensuring that optimal use is made of the water, sanitation and hygiene enabling facilities
that are provided

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Additional information on the principles of hygiene promotion, as well as differences between HP and hygiene/health education is
provided in Annex 3.

4.1

Priority hygiene areas for cholera response

1. Priority (prevention) activities will focus on treating and reducing contamination of drinking water at household level,
handwashing at critical moments and safe excreta and vomit disposal. The HP sub-Cluster will support Health case
management activities through demonstrations on preparation and administration of ORS at household level, as well as
encourage sick persons to present themselves at health facilities.
2. Hygiene promotion might need to focus on different aspects of the priority activities, depending on context, identified
transmission routes, key risk behaviours and misconceptions (eg. where people have access to treated water, emphasis
on safe storage and handling, not on treatment. Or people wash hands after defecation before eating but not after contact
with excreta or vomit of sick persons).
3. However, only a few risk practices should be targeted for effectiveness whatever the situation. The priority messages for
the HP sub-Custer are given below based on the assumption that all Departments are now affected by cholera:

Areas affected by
cholera

Prevention
1. Only use water that is treated. Water containers need
to be kept covered to keep the water clean. Drawing
water from the container in an unhygienic way can
contaminate the water.
2. All family members, including children, need to wash
their hands thoroughly with soap and water after
contact with faeces, after contact with faeces or
vomit of sick persons, before touching food, and
before feeding children.
3. All excreta, and especially excreta and vomit of sick
persons should be disposed of safely.

Management and Referral

1. Taking ORS at the first sign of
diarrhoea
greatly
reduces
dehydration and saves life.
2. Go to the nearest health facility at
the first sign of diarrhoea even
after taking ORS

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4.2 Hygiene promotion in earthquake affected

areas
Camps

Promotion of aforementioned cholera response messages has been ongoing since May. The HP sub-Cluster Rainy Season
Plan focused on these messages in anticipation of diarrheal disease outbreak during the rainy season (June-August).
Activities should focus on reinforcing messages and ensuring maintenance and use of available latrines. Safe excreta
management in camps is a priority as not all camps had achieved minimum latrine coverage during the earthquake
response. Close collaboration is needed with the Sanitation sub-Cluster to ensure safe excreta disposal for the duration of
the epidemic. Agencies working in camps should especially ensure handwashing facilities are provided in all camps
according to the standards defined for the earthquake response. Regular distribution of key hygiene supplies, especially to
the vulnerable should continue, while ensuring the minimum standard of 1:500 community mobilisers is achieved.

There should be close collaboration with CCCM/IOM to ensure coverage of camps with no WASH actors. Health campaigns
and distribution of key supplies should be carried out initially (Phase I), while identifying and recruiting community
mobilisers for HP training.

Markets

In metropolitan Port au Prince, HP activities will be carried out in collaboration with the solid waste group focal point
(public works ministry), under whose docket markets fall under. Public works shall identify key HP focal points for each
market that will be trained through HP sub-Cluster support. These focal points will work in close collaboration with
promoters from agencies carrying out HP activities in markets. The HP sub-Cluster will work closely with the Sanitation
sub-Cluster to ensure provision of basic enabling services in markets, especially where markets can be connected to the

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Camep distribution network for water supply to enable hygienic practices. Basic WASH services will consist of bucket
chlorination, and provision of handwashing facilities where possible. The HP sub-Cluster will advocate for HP/WASH actors
to adopt markets located in their areas of activity to ensure widespread HP coverage of a key transmission route. The
Public Works focal person will avail a list (or map) of markets and their location in the Port au Prince metropolitan area for
this purpose.
Neighbourhoods (around camps)

Strategic approaches are needed for HP in neighbourhoods given the limited (human) resources within agencies. Well
planned mass media and information campaigns targeting specific audiences should be a key communication option.
These should be supported by interpersonal communication using community mobilisers from surrounding camps.
Agencies are encouraged to dedicate some of their camp-based resources to target the communities around the camps
where they are working. A minimum of 1 day a week should be dedicated to neighbourhood HP activities. The radius
should be determined based on available resources, including community mobilisers and hygiene promoters. Identification
of vulnerable groups where household visits should be carried is essential. Planning should be done to ensure home visits
to vulnerable groups are accompanied with distribution of basic supplies to support adherence to key hygiene practices.
Existing neighbourhood committees should be identified and targeted including providing basic orientation/training on
HP to assist in mobilising neighbourhood communities.

Schools

Schools are an important medium for change through children. Support to schools should be ensured through hygiene
promotion sessions with teachers and pupils, distribution of key hygiene supplies (aquatabs, soap) and provision of water
supply. Distribution of child-friendly posters/brochures, painting hygiene messages on walls, drama and song are methods
that can be used to effectively reach children. WASH in schools activities should be coordinated with the Education Cluster.

Rural

This includes areas bordering and outside the Port au Prince metropolitan zone, sometimes mountainous in characteristic.
These are characterised by little or no WASH actor presence. In addition to strategic mass campaigns, partnership with
local actors and existing community networks will be indispensable to effective hygiene promotion. CAZECz, AZECs and
other local authorities will have information on existing community organisations in their areas of jurisdiction.

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4.3 Hygiene
affected areas

promotion

in

non-earthquake

With the exception of Artibonite, the number of operational WASH actors is still very low with some areas having no WASH
actors almost 3 months after the cholera outbreak. Building local capacity (NGOs, local authorities, community
associations and volunteer networks) for hygiene promotion, through training, should be a key strategy for HP activities in
non-earthquake affected areas.

Public places, such as markets and bus stops, and schools should be primary targets for HP in non-earthquake affected
areas. Sensitisation through mass media will be significant in the initial phase of the response, in areas with no WASH or
other actors. However, interactive community mobilisation for behaviour change should be undertaken as early as
possible if HP objectives are to be achieved. Volunteer networks are crucial in the initial phase as there will be little time to
recruit and train dedicated HP facilitators. These can be identified through local authorities, churches, community health
workers, local NGOs and national societies (Haitian Red Cross). However, community mobilisers should be identified and
trained as soon as possible.

Involving community organisations and local partners in sensitisation activities will increase compliance and coverage in
areas with no WASH or other actors. Assistance should be sought from local authorities and partners in mapping existing
community networks. Collaboration with the Health and Agriculture Clusters will also help in identifying and engaging
community networks and sub-national officers for sensitisation activities, especially in rural areas. Agencies having both
WASH and health (or other sector) programmes in these areas should coordinate internally to effectively use existing
programmes and networks for HP activities.

Joint planning meetings at sub-national level will help determine the best approaches for non earthquake affected areas.

4.4
Stigmatisation of cholera affected
persons

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In view of the stigma currently associated with cholera, establishment of cholera support groups to provide community
support structures to sick persons and their families is recommended. These groups would be composed of 2 or 3
neighbours. They would have basic orientation on cholera prevention measures, early basic treatment (ORS) and referral
measures. Their role could be to assist sick neighbours get to hospital and provide moral support to affected families.
They could also serve as focal points for prepositioning of ORS in communities without access to ORPs. Having a contact
list of numbers of motos or tap-tap drivers that could transport sick persons to hospital and nearest CTCs/CTUs is an
example of practical support these groups could provide. They could be part of the trained community outreach workers.

Information campaigns should be launched to address misconceptions in relation to cholera. A technical working group
(TWG) on Cholera Stigma has been formed, enjoining HP and Health partners that include psycho-social actors. The TWG
will produce a guiding paper on the subject that will include approaches and messages to deal with it.

4.5

Training of community mobilisers

Effective HP will require well-trained and supported hygiene promoters and community mobilisers. Community
participation approaches rely on well trained and confident workers, to encourage and facilitate behaviour change through
action planning and follow-up. A total of 18,000 community mobilisers and hygiene promoters are needed in order to
achieve nationwide coverage based on the 1:500 minimum Sphere standards (or 1:300 where households are far apart).
There are currently about 5,000 community mobilisers and hygiene promoters working in the earthquake affected areas.
An additional 13,000 are needed to ensure coverage of all cholera affected populations.

Training in basic promotion techniques and key (cholera) preventives messages approved by MSPP can be provided
initially. Other topics for good facilitation skills can be added gradually in follow-up trainings. Additional/refresher trainings
are recommended beyond the initial phase of the response and should be factored in agency plans. Essential skills and
knowledge required by facilitators are presented in Annex 4.

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Recruitment and training of community mobilisers and hygiene promoters should target priority areas first and ensure all
Departments/Communes/Sections Communales are covered. Initially mapping of existing community mobilisers per
commune should be carried out to determine gaps and identify potential mobilisers to train. As it will not be possible to
achieve total coverage immediately, realistic targets should be set for the different phases of the response. Coordination
of the various trainings planned by the WASH and Health Clusters is crucial to avoid duplications, ensure priority areas are
targeted first and the entire country is covered by joint efforts. A meeting between WASH and Health donors/agencies
supporting the trainings is recommended.
While a cascade outreach system is currently being favoured, carefully planning is needed for several reasons:
Level of education of targeted mobilisers 60% of the population cannot read or write easily. Training courses and
approaches must take this into account and will require skills in participatory methodologies
Training in use of participatory methodologies requires skilled trainers
The cascading approach results in the dilution of training effectiveness. Every time a trainee becomes a trainer some of
the information is lost. Ensuring quality of training being passed on from trainer to trainer will require monitoring and
support of mobilisers by hygiene professionals
Ensuring trained mobilisers are committed, have time to devote to activities and actually use their training.
Complexities of ensuring effectiveness of this approach means training of many people might not be possible as huge
resources will be required to monitor for effectiveness.

A common cholera-specific training curriculum including tools and manuals should be agreed on, in order to promote
common standards and approaches between actors in cholera preparedness and response. A review of training curricula
being developed, as well as relevant pre-existing trainings (eg Global WASH Cluster HP training, MSPP/WHO training,
UNICEF (ESARO) Cholera/AWD EP & R training) is necessary. The review will help to identify what is most appropriate for
Haiti, including a possible mix of available trainings. Joint trainings within the HP sub-Cluster, and with Health partners are
encouraged to enhance coherence in approaches and standards.

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Remuneration of community mobilisers will require discussion and agreement given the different approaches currently
employed by actors. A joint Health and WASH working group should be constituted to identify the best approach on the
issue.

4.6
Communication channels for promoting
hygiene

Communication is at the heart of making people aware of right hygienic practices and the benefits of investing in them.
Identifying target audiences for the messages will be crucial in determining the best channels to use. Target audiences are
either primary (those carrying out risk practices), secondary (those supporting or hindering primary audience
behaviour) or tertiary (decision makers, leaders and people whose support is needed for the success of HP porgrammes).
Channels of communication can be divided into three types:

o One- to- one eg. household visits

o Group eg. meetings, video and film presentations, hygiene campaigns, community events, drama and theatre,
focus group discussions

o Mass eg. radio broadcasts, TV, posters, billboards, public address systems such as meagaphones

Finding out how target audiences communicate is important in defining a good communication plan. For example, if
targeted women are housewives with little contact with channels of communication outside their homes, then household
visits will be required. Radio might be a popular means of communication but if men carry the radios with them, then
targeting men not women - through radio might be better.

A mix of channels that balance maximum reach and effectiveness with minimum cost should be selected. Mass
communication, such as radio, reaches more people cheaply, but has lower capacity to affect behaviour because there is
less opportunity for dialogue. One-to-one communication is highly effective in getting a message across but is time
consuming and requires many promoters. An intermediate solution would be to address groups of target audiences at
meetings, special events or video showings. Additionally, literacy levels of targeted audiences will affect the choice of
channels used. A good communication plan is needed to ensure that whatever channels are identified should give the

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same messages, reinforcing one another. A summary of the different HP contexts and proposed channels of
communication is attached as Annex 5.
Table 1: Sample target audiences and how they could be targeted

Target
Audience
Primary

Who

Where

Channels of Communication

Objective

Poor
mothers,
children, care givers

Home, markets,
fields, churches,
schools

Weddings, home visits,

theatre, school lessons,
women meetings

street
video,

Change hygiene
practices

Secondary

Fathers, mother-in-
law,
teachers,
neighbours, etc

Radio, TV, meetings, newspapers,

leaflets, video projections, special
events

Support
changes
hygiene
practices

the
in

Tertiary

Religious,

community
and
political leaders

Neighbourhood,
work
places,
meeting places,
bars, churches,
sports
Offices,

churches,
temples, capital

Radio, TV, leaflets, seminars, print

media, ceremonies, meetings

Support
hygiene
promotion
programme

the

An important hygiene promotion principle in communication is not to overload targeted audience with too much
information at one time and to focus on a few practices at a time. A maximum of 3 is best. Prioritisation of messages
should be guided by specific context and situation needs.

An inter-Cluster communication working group should define a common communication plan for a standardised approach
across Clusters. The group should also review existing communication material for appropriateness and propose common
materials for use by all actors. Printed materials such as brochures, pamphlets and posters should be designed bearing in

Linking messages with livelihoods is recommended as people often do not see health benefits as the primary reason for
improving their hygiene. Cholera is a livelihoods issue in Haiti and this should be capitalized on for effective behaviour
change. Example, a message to market vendors could be women will lose their livelihoods if they dont stay safe by
drinking treated water. If theyre sick and stay home, they cannot go to the market to sell!

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mind that about 60% of the urban population and 63% of the rural cannot read or write easily. All materials must be
validated by MSPP before use for any hygiene promotion activities.
4.6.1 Communication materials for HP activities
All materials for HP activities must be approved and validated by MSPP. No materials should be used for HP activities if
they have not been approved by MSPP. An updated list of all validated materials will be made available to HP sub-Cluster
members. Materials for HP requiring validation include:
Training manuals for hygiene promoters and community mobilisers
Tools and aids for promoters and facilitators eg. Boites a images, posters

5.

Mass communication materials eg. posters, fliers, leaflets, videos,

Enabling factors for HP

HP activities need to be supported by provision of WASH services to enable effective behaviour change. Provision of WASH
services (including infrastructure) has been ongoing in earthquake-affected areas since January, mainly in camps.
Activities outside camps have been limited to rehabilitation of community wells and construction of family latrines in a few
areas outside the Port au Prince metropolitan. Agencies working in earthquake-affected areas should ensure that WASH
services meet agreed minimum standards. Joint planning with the sanitation sub-Cluster is necessary to identify feasible,
impact-evidence actions to improve access to WASH services in non-earthquake affected areas. Examples are water
supply to schools, bucket chlorination and handwashing facilities (with soap) at markets. These should be linked with
longer-term initiatives such as the community led total sanitation initiative currently being piloted in the West, North East
and South West Departments.

Systematic distribution of key hygiene supplies to affected populations should be carried out in the first phase of the
emergency. Distribution in IDP camps should continue throughout all phases of the emergency. The most vulnerable
groups should be identified and also targeted for regular distribution in all affected Departments. Key supplies should
meet Sphere minimum standards and include the following:
o Soap
o Aquatabs, Gadyen Dlo or other locally appropriate chlorination product
o Cholorox, jif for disinfection

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o
o

Storage containers for household water treatment and storage. Containers should have narrow necks and caps or
have lids and taps from which to draw water
ORS (HP sub-Cluster advocates only for prepositioning of ORS with community focal points in areas with no access
to ORPs)

Distribution of hygiene supplies needs to be accompanied by sensitisation activities on proper use of items and
mobilisation of hygiene promoters to accompany distributions needs strategic planning. Joint planning meetings with all
actors to coordinate distributions at sub-national are indispensable to success of distribution activities in non earthquake
affected areas. All planned agency distributions should be coordinated with ongoing DINEPA distributions to avoid
duplications. DINEPA has a distribution coordinator for every Department and agency plans should be communicated to
the coordinators. Existing non-WASH programmes, local authorities and community networks should be targeted to
support distribution activities in areas with no WASH actors. Best practices and lessons learned will need to be captured in
order to determine the most effective way to reach targeted populations.

6.

Monitoring

Monitoring will be carried out at two levels: i) Progress monitoring to measure achievement of targets set for different phases
and ii) Impact monitoring to evaluate behaviour change as a result of interventions. Monitoring and evaluation of hygiene
behaviour change will focus on a limited set of indicators.

7.

Coordination

In order to enhance coordination of HP activities, the following principles are proposed:

Standardized approaches in response delivery for the following areas: training of hygiene promoters and community
mobilisers. Joint trainings are encouraged; Information, communication and education (IEC) materials, including
training manuals and facilitator tools;
Establishment of a clear sharing of roles and responsibilities between the WASH/HP sub-Cluster and Health Cluster, in
order to improve inter-cluster collaboration and coordination

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Identify and maximise opportunities for synergies between all actors through joint planning at Department/Commune
level, particularly at sub-national hubs. Joint planning should ensure clear definition of partner activity zones for HP to
avoid overlaps. The Municipal Coordination Mechanism (Port au Prince) WASH activity zoning principle should be
applied, especially in non earthquake affected areas. The principle involves demarcation of activity zones for agencies
and nomination of a focal agency for each Commune.
Work in coordination and support of government authorities at all levels using existing systems to implement response
where possible.
Definition of priority focus areas for HP in non earthquake affected areas should be determined at sub-national hubs.
Sub-national level hygiene promotion working groups exist in a few Communes. Where these already exist, they will
identify priority focus areas for HP activities, ensure joint planning with other key actors, map existing community
mobilisers and identify needs/gaps in capacity and resources for their respective areas. The groups should ensure
coordination with other forums in their respective areas, as well as with the national level HP sub-Cluster.
Focal HP points will be appointed for priority Departments/Communes to ensure feedback of achievements, needs and
gaps to the national level HP sub-Cluster.

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Annexes 1: Table of HP activities

Activity

Phas
e

Non-WASH
partner
involveme
1 2 3 nt

Geographical
area

Where

Who

WASH Priority
areas/hot spots

Community,
market

NGOs

Health

All affected
Departments,
beginning with hot
spots
All affected
Departments/WASH
priority areas
All affected
Departments/WASH
priority areas

Camps,
communities,
markets

NGOs, CDAC, CDC

CDAC

Camps,
communities,
markets, schools
Camps,
communities,
markets, schools

NGOs, DINEPA, community

outreach workers,
community
CDC, CDAC, NGOs,
community outreach
workers, community

Planning
Identify capacities, needs and gaps, and development
of joint HP response plans

WASH priority areas

Sub-national hubs

Identify viable, high impact, low cost WASH services

for implementation, to enable hygienic behaviour

WASH priority
areas/hotspots

Markets,
communities,
public places,

Sub-national WASH
Clusters/Hygiene promotion
working groups, local
authorities
HP sub-Cluster and
Sanitation sub-Cluster

Assessment and monitoring

Rapid assessment to identify risk practices and get an
initial idea of what people know, do and understand
about WASH and cholera
Baseline surveys/pre- intervention KAP surveys

Progress monitoring of achievement of set targets

Impact monitoring (Post KAP surveys)

Health,

Education

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Map existing community mobilisers and community

organisations/networks to identify trainees for
hygiene promotion

All affected
Departments

schools
Commune level

HP sub-Cluster coordinator,
sub-national WASH Cluster
coordinators, local
authorities
HP sub-Cluster

Health

Identify and review of existing IEC materials for

appropriateness
Identify market focal points for HP training

PAP metropolitan

markets

Public Works ministry focal

point

Implementation
Training of hygiene promoters and community
mobilisers

WASH priority
areas/hotspots

Community, NGOs

Health

PAP metropolitan
and eventually all
affected Communes

markets

NGOs, Donor agencies and

facilitative agencies (USAID,
WHO, UNICEF)
HP sub-Cluster
NGOs, MSPP (CDAC/MSPP
for validation of materials)

Health

Training of market focal points

Development of training materials and facilitator aids

MSPP/CDAC

Public Works

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Provision of basic WASH services

WASH priority
areas/hotspots

Markets, schools,
public places

Distribution of basic hygiene supplies (distribution to

most vulnerable groups in all affected Departments)

WASH priority
areas/hotspots

Prepositioning of ORS with community focal points

WASH priority
areas/hotspots

Households
(camps,
community),
markets, schools
Camps,
community,
schools

Hygiene promotion campaign

Define target audience and priority focus (eg primary
care givers)

All affected
Departments/Comm
unes

Audiovisual mass media campaign (radio spots, TV,

video/film)
Traditional media (dances, drama and theatre, song)

All affected
Departments
All affected
Departments

Public broadcasts (megaphones)

All affected
Departments
All affected
Departments

Print media (posters, pamphlets, cholera/publications,

bill boards) with simple, few messages and emphasis
on graphic illustrations
One-to One (face-to-face) and group (focus group)
communication with distribution of simple pamphlets
with graphic illustrations on use of key hygiene
supplies

WASH priority/
hotspots

Setting up of community cholera support groups

All affected
Departments
beginning with
WASH priority areas

Education

NGOs

Health,
Education

Community,
camps, markets,
public places (eg
bus stops)
Camps,
community,
Camps,
community,
schools
Public places,
markets camps
Schools, public
places, camps,
community

HP sub-Cluster

Household level
(camp,
community),
community and
camp meetings,
markets, teachers
Community, camp

NGOs, community outreach

workers

Printing of IEC materials for HP activities

Coordination
Organise and facilitate HP coordination meetings
(Joint meetings with Health and other sub-national
forums where there are no HP working groups)

NGOs, Sanitation subCluster, Public Works

ministry
NGOs, DINEPA

Health,
Education

CDAC

NGOs

CDAC

NGOs, community outreach

workers

Education

NGOs
NGOs

NGOs, community outreach

workers

Health,
CDAC,
Education
Health,
Education

Health

NGOs

All affected
Departments

National and subnational hubs

HP sub-Cluster coordinator,
sub-national HP working
groups

Health

Produce who, what where thematic maps on HP

activities
Agency reports on HP activities (using agreed format)

All affected
Departments
All affected
Departments

WASH Cluster IM
NGOs

Annex 2: Goals, objectives, outputs, indicators

OVERALL OBJECTIVE/GOAL
Reduce mortality, transmission and impact of the cholera epidemic
SPECIFIC OBJECTIVE
Children, women and men are aware of the cholera health risks and are mobilised and enabled to take action to
prevent or mitigate outbreak risks by adhering to safe hygiene practices.

Outcomes
Increased hygiene awareness and adaptation
at household and community levels
Increased community participation and
representation

Outputs
Competent and functioning hygiene promotion
teams at NGO and community level
Better informed and organised communities

Indicators (impact)
70 % of men, women and children washing their hands correctly
after contact with faeces/vomit and before handling food
Adequate water handling practices to treat and minimise
contamination practised by at least 70% of households
At least 70% of households in camps and communities safely dispose
of faeces and vomit
Majority of community members, including the most vulnerable, have
been consulted and are satisfied with HP interventions
Indicators
% of households with at least one or more persons who have
participated in consistent, participatory HP sessions
% of every household having at least one person who knows 3 key
ways to prevent cholera and what to do in case of symptoms

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Improved access to safe drinking water

People enabled to practise the target hygiene
behaviours

% of communities with cholera support groups

Basic hygiene supplies are available at 70% of households, schools
and camps

Activity target indicators

Activity targets Phase 1

Activity Targets Phase 2

Activity Targets Phase 3

Training of 3,000 mobilisers (ratio:

1,125)
80% of HH reached through mass media
40%
of population in WASH priority
areas reached through one to one and
group communication
70% of households in affected areas
have received basic hygiene supplies
(vulnerable populations, cholera patient
families)

Training of 5,000 mobilisers (ratio 1:700)

100% of HH
reached through mass
media
60% community reached through one to
one and group communication
80% of households in affected areas
have received basic hygiene supplies
(vulnerable populations, cholera patient
families)

Training of 5,000 mobilisers (ratio: 1:500)

100% of HH reached through mass
media
70% community reached through one to
one and group communication
100% of households in affected areas
have received basic hygiene supplies
(vulnerable populations, cholera patient
families)

15