Scaling up handwashing behavior : findings from the impact evaluation baseline survey in Peru : global scaling up handwashing project

In response to the preventable threats posed by poor sanitation and hygiene, the Water and Sanitation Program (WSP) launched two large-scale projects, Global Scaling Up Handwashing and Global Scaling Up Rural Sanitation, to improve the health and welfare outcomes for millions of poor people. Local and national governments are implementing these projects with technical support from WSP. Global Scaling Up Hand washing aims to test whether hand washing with soap behaviour can be generated and sustained among the poor and vulnerable using innovative promotional approaches. The primary objectives are to reduce the risk of diarrhoea in young children and increase household productivity by stimulating and sustaining the behaviour of hand washing with soap at critical times. Overall, the project aims to generate and sustain hand washing with soap practices among 5.4 million people living in Peru, Senegal, Tanzania, and Vietnam, the four countries where the project has been implemented to date. Hand washing with soap at critical times has been shown to substantially reduce the incidence of diarrhoea. It reduces health risks even when families do not have access to basic sanitation and water supply. Despite this benefit, rates of hand washing with soap at critical times remain low throughout the world. In an effort to induce improved hand washing behaviour, the project intervention borrows from both commercial and social marketing fields to bring about the desired outcomes. Behaviour change communications campaigns and messages developed by the project have been designed and strategically delivered across multiple, integrated channels, in multiple settings, to “surround” target audiences with hand washing promotion. One of the project’s global objectives is to learn about and document the health and welfare impacts of the project intervention. To measure the magnitude of these impacts, the project is implementing an impact evaluation (IE) using a randomized-controlled experimental design in each of the four countries to establish the causal effect of the intervention (treatment) on specific health and welfare outcomes. The IE includes several rounds of household and community surveys: pre-intervention (baseline), concurrent (longitudinal), and post-intervention (endline). The surveys are designed to collect information on the characteristics of the eligible population and to track changes in desired outcomes. This technical paper presents the findings of the WSP impact evaluation (IE) baseline survey in Peru and is one in a series of papers presenting IE findings from surveys conducted in each project country. The hand washing project in Peru, implemented in 788 randomly selected districts located in 104 provinces, comprises a primary audience of mother/caregivers and children; the secondary targeted audience includes community-based agents such as schoolteachers, health promoters, and local leaders. In Peru, the project objective is to reach women (ages 14–49) and children (ages 5–12) in order to stimulate and sustain hand washing behaviour change in a total of 1.3 million of those reached by project end. [authors abstract]