What can be done to improve hygiene programming in Humanitarian Emergencies?

The Environmental Health Group has recently embarked on a new project with Action Against Hunger (ACF) and the Centre for Affordable Water and Sanitation Technology (CAWST) to improve the way hygiene programs are designed in humanitarian crises.

At LSHTM this work is being led by Sian White  we spoke with her to find out more about the importance of the project.

Why is this study important?

Well we now have good evidence that diarrhoeal diseases and respiratory infections remain the largest cause of preventable death among children under five. We also know that that the simple act of handwashing with soap has the greatest potential to reduce the burden of these diseases as well as a range of other pathogens that spread via the faecal-oral route. Over the last decade substantial research and programmatic investment have gone into better understanding the determinants of people’s handwashing behaviour. This body of literature has highlighted determinants such as social norms; the physical environment where handwashing takes place; the availability of soap and water; disgust associated with visible dirt; the influence of social networks; and many more. However, this research base is derived entirely from work conducted in stable (non-emergency) settings. When a humanitarian crisis occurs, whether it be a disease outbreak, a natural disaster or an armed conflict, the social and physical environments of the affected population are disrupted. At the same time, disease risk related to faecal-oral pathogens substantially increases. This research starts with the hypothesis that under such exceptional circumstances the determinants of handwashing will also change. The partners involved in this grant feel that exploring the determinants of handwashing behaviour in different types of emergencies is an essential first step for improving the quality of hygiene programming in emergencies. In the long term we hope to use the findings from this research to develop an application-based, decision-making tool that will go one step further in aiding humanitarian actors to design rapid but evidence-based hygiene programs tailored to specific humanitarian contexts.

What will be involved in the research?

The study will involve a multi-stage literature review that will help to generate hypotheses to test in the field research. The field research will involve interviews with humanitarian actors to understand the way hygiene programs are currently designed and the constraints actors have to operate within. The second part of the field work will involve two mixed-method case studies. The first of these will be in the Kurdistan Region of Iraq, which has been selected as an example of an armed conflict. The second case study will take place in the Democratic Republic of Congo and this has been chosen since it is a nation which experiences regular cholera outbreaks.

What has been done so far?

To date I have been working on two literature reviews. The first brings together evidence about the determinants of hygiene in stable settings. A summary of the results from this review can be found here:Systematic qualitative literature review. The second review is of grey literature and includes the documents that humanitarian actors commonly use to design hygiene programs.

I have also just returned from my first visit to the Kurdistan Region of Iraq where I finalised the camps and communities where we will be working and conducted interviews with actors in WASH Cluster.


This research is being funded by United States Agency for International Development (USAID).

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