This document summarizes Tanzania's experience with a program to promote handwashing with soap. The program worked with the government and districts to encourage households to improve and maintain handwashing behaviors. It found that knowledge of handwashing was high but practice was low. To change this, it focused communication on rural mothers by recognizing their important role and portraying handwashing as simple, easy, and able to make a difference for their families' health. An assessment found some initial success, with 18% of households in one district having functioning handwashing stations and soap after the program. The document emphasizes the importance of understanding target audiences and incentives for volunteers.

1. Making ‘what works’ work: Changing behaviour in sanitation and hygiene Wednesday 20 July 2011Session jointly convened by LSHTM/SHARE, WSSCC, UNICEF and WSP Global Scaling Up Hand washing Project -Tanzania Experience Nyanzobe Hamisi Malimi, WSP

2. Program snapshot Working with national government and 10 districts to learn how to prompt households to improve and maintain their hand washing behaviours. Implementation 2009-2011: Scaling up and hand washing with soap at critical junctures

3. Why Tanzania investing in hand washing? 30,000 people die annually due to diarrheal diseases. 12.6 percent of children suffer from diarrheal diseases. Acute respiratory infections (ARIs), an average prevalence of 8% (DHS, 2004-05 report). Knowledge of the reasons to wash hands was high but the practice was low. Hand washing with soap can reduce diarrheal incidence by 42-47% (Curtis and Cairncross 2003) 3

5. Good at making ends meet with what they have .

8. HWWS too complicated,

9. Yet another burden

11. They feel nobody notices their efforts

14. Strategy for communication

15. Phases for behaviour change

16. Outputs

17. Outcome Rapid assessment and Impact assessment will be conducted from August 2011. Spot check in Kiteto District Feb, 2011: Tippy tap as indicator Kiteto District has 3,498 house holds 18% of House holds has fuctioning tippy taps and soap. 12

18. Lessons and way forward Understanding the consumer is necessary to develop the right message, ways of communication and technology. The use of hand washing volunteers needs proper system for incentives within the Government structure. Performance monitoring need strengthening HWWS indicators included in MoH Results Framework  mentioned in TZ Nationa Strategy for Growth and Poverty Reduction (NSGPR) Integtating Hand washing in National Sanitation Campaign from July 2011 for 42 Districts.

19. Contact details and resources nmalimi@worldbank.org www.wsp.org/wsp/

20. THANK YOU!