The hygiene promotion (HP) assessment should identify the main public health risks and current hygiene practices that contribute to the risks A.2. It should determine which individuals and groups are vulnerable to which WASH-related risks (A.7 and chapter  E ) and why. It should identify factors that can both hinder and motivate positive behaviours and preventive action (A.2 and chapter  B )

Assessing WASH-related public health risks and how to address them will require an understanding of:

• Current use of WASH facilities and services,
• Access to essential household hygiene items P.6‚
• Current coping strategies, local customs and beliefs,
• Social structures and power dynamics in the community A.7,
• Where people go for healthcare (including traditional healers, pharmacies, clinics),
• Who is responsible for operating and maintaining WASH infrastructure,
• Disease surveillance data linked to WASH,
• Social, physical and communication barriers to accessing WASH facilities and services, particularly for women and girls, older people and persons with disabilities,
• Income-level variations,
• Environmental conditions and seasonal trends for diseases.

The assessment must also try to understand the social and behavioural factors (chapter  B ) that influence different peoples’ hygiene practices and how these can be used to influence change as shown in teh figure below.

It will also need to identify the communication preferences of different groups to design an effective response (chapter  C ).

 

Process & Good Practice

• Consider different community groups (e.g. men, women, adolescents, elders and people with disabilities) and identify those who are marginalised or particularly vulnerable (A.7 and chapter  E ). 

• Recognise that the affected community are ‘experts’ in their situation and have knowledge to share. 

• Remember the importance of communicating with people in their language and ensure that interpreters are well briefed before commencing the assessment C.7. 

• Use the ‘F’ diagram, influences on health graphic A.2 and social and behaviour change models B.2 to help identify a broad range of assessment factors and continue to deepen understanding as the programme progresses.

• Aim to answer the following ten questions through the HP assessment: 

  • What were ‘normal’ practices before the emergency and how have people adapted to the emergency? 
  • What are the widespread ‘risky ‘practices in the community? 
  • What are the different motivators and barriers to practising safer hygiene for different groups? 
  • How can we enable changes in practice and improvements in hygiene? 
  • Who uses ‘safe’ practices and who and what motivates and influences them to do so – can this be used to influence others? 
  • What communication channels are available and which are trusted for promoting hygiene? 
  • What facilities or materials do people need in order to carry out the ‘safe’ practices? 
  • How much time, money or effort are people willing to contribute for those facilities/materials? 
  • Where will those facilities/materials be available? 
  • How will people know that the facilities/materials exist and where they can be obtained?

• Use different senses to gather information. It is not enough to just ask questions; use other senses such as Observation T.28 to cross check and deepen understanding. 

• Some questions about hygiene can seem intrusive and there may be taboos about some issues e.g. menstrual hygiene P.7. It can be useful to ask such questions indirectly such as ‘what do women here do?’ rather than ask ‘what do you do?’