2012年-世界发展银行全球_Global_Scaling_Up_Handwashing_Project___Results_Impacts_and_Learning_from_Vietnam_8页_2mb

Summary of the Global Scaling Up Handwashing Project in Vietnam

Core Content

The Vietnam Handwashing Initiative (HWI), part of the Water and Sanitation Program's (WSP) Global Scaling Up Handwashing Project, was launched in January 2006 with the aim of reducing diarrheal diseases and other illnesses in children under five years of age through improved handwashing with soap behavior. The project ran from 2006 to 2010, involving 10 provinces and 500 communes, and aimed to design, implement, and sustain large-scale handwashing programs while measuring their impact on health and welfare outcomes.

The initiative employed a multi-channel approach, including mass media, community-based events (Direct Consumer Contact or DCC), and interpersonal communication (IPC) activities led by Vietnam Women's Union (VWU) members and health workers. The program also aimed to strengthen the enabling environment for handwashing, integrate handwashing with soap into broader health and sanitation programs, and share evidence-based learning for future initiatives.

Key Objectives and Targets

• Design and implement a large-scale handwashing behavior change program
• Strengthen the enabling environment
• Monitor and evaluate behavioral, health, and welfare impacts
• Share evidence-based learning and guidance

Main Findings and Insights

Behavioral Impact

• The program successfully reached its target audience and increased knowledge about handwashing.
• However, no significant changes in handwashing behavior were observed in children under two years of age, and no health impact was found in this group.
• Self-reported handwashing increased, but direct observation showed low compliance with key handwashing times, such as before feeding a child.

Enabling Environment

• The vertical government structure facilitated rapid scale-up of IPC activities.
• Interpersonal communication via frontline workers, VWU members, and teachers was identified as the most sustainable channel.
• Integration of handwashing into existing health and sanitation programs was essential for sustainability.
• The Handwashing with Soap Integration Kits were developed to support this integration.

Challenges in Behavior Change

• Changing behavior at scale remains a major challenge, even with high knowledge and access to soap and water.
• The RCT evaluation suggested that the intensity and quality of messaging may not have been sufficient to drive significant behavior change.
• Social norms and community influence were not fully explored in the initial phase, despite their importance in behavior change.

Product and Infrastructure

• A commercially produced handwashing station was developed, and do-it-yourself stations were not well-received by rural households.
• Households preferred new, attractive, and durable products that could be installed in visible locations.

Learning and Replication

• The project contributed to the development of evidence-based communication programs and behavior change frameworks.
• It influenced hygiene promotion programs in other countries, including Bhutan, through the use of FOAM and SaniFOAM frameworks.
• Post-2011 progress included scaling up to 15 additional provinces, training more frontline workers, and expanding into 790 communes and 758 schools.

Key Takeaways

• Efficient scale-up was possible due to the centralized government structure and strong partnerships.
• Interpersonal communication is critical for sustaining handwashing behavior.
• Behavior change at scale is complex and requires more than just knowledge dissemination.
• Social norms and community influence are important drivers of behavior and should be more deeply explored in future programs.
• Product design and availability are key to consistent handwashing behavior, especially in rural areas.

Recommendations

• Invest in frontline worker capacity to improve message delivery and behavior change.
• Focus on social norms and community engagement in future hygiene promotion efforts.
• Design attractive and durable handwashing stations that are suitable for rural households.
• Continue integration of handwashing into existing programs to ensure sustainability.
• Use evidence-based frameworks and learning from other countries to improve program effectiveness.

Conclusion

The Vietnam Handwashing Initiative demonstrated the potential of large-scale communication programs to improve knowledge and awareness of handwashing. However, it also highlighted the challenges in achieving lasting behavior change and the importance of a supportive enabling environment. The project’s findings have contributed to the global understanding of hygiene promotion and continue to inform future initiatives in Vietnam and beyond.