the issue

the grim global picture

the global challenge

the grim situation in east africa

the challenge in east africa

approaches applied



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WELL FACTSHEET - Regional Annex for East Africa

Personal Hygiene Behaviours

Author:  Gerald Rukunga, AMREF, Kenya, 2005

Quality Assurance: Eveline Bolt


The Issue

To achieve the greatest health benefits from water supply and sanitation provision improvements in hygiene should be made concurrently. For people to utilize and benefit sustainably from water and sanitation facilities they must adopt the appropriate hygiene practices and therefore hygiene promotion should be an integral part of water supply and sanitation.

The Grim Global Picture

1.1 billion people in the world do not have access to safe water, and 2.6 billion do not have access to adequate sanitation. It is estimated that 2.2 million people in developing countries, most of them children, die annually due to diarrhoea linked to lack of access to safe drinking water, inadequate sanitation and poor hygiene (WaterAid 2006).

Poor water quality continues to pose a major threat to human health. Diarrhoeal disease alone amounts to an estimated 4.1 % of the total DALY global burden of disease and is responsible for the deaths of 1.8 million people every year. It was estimated that 88% of that burden is attributable to unsafe water supply, sanitation and hygiene and is mostly concentrated on children in developing countries, (WHO, 2004).

The Global Challenge

Provision of safe water supply and sanitary conditions coupled with sustainable proper personal hygiene can drastically reduce this burden.  

Hygiene behaviour plays an important role in the prevention of diseases related to water and sanitation, such as cholera, typhoid, dysentery, diarrhoea and intestinal worms. Providing water and sanitation facilities does not necessarily lead to a decrease in these diseases. For real impacts to be felt, provision of these facilities has to go hand in hand with their proper use and maintenance.  This is achieved by persuading people to change their behaviour in order to reduce ‘risk’ practices that predispose them to hygiene and sanitation related diseases.  

Campaigns to promote hand washing with soap, food protection, domestic hygiene and safe excreta disposal,  in particular of infants’ stools, have been shown to deliver big health gains. The simple habit of hand washing if widely adopted would save more than one million lives around the world annually, the majority of them children under the age of five in poorer countries. The simple act of washing hands with soap can reduce diarrhoea by over 40% (WaterAid 2006). Better hygiene through hand washing and safe food handling reduces child diarrhoea by 35%, improved water quality by 15-20% and safe disposal of children’s faeces by nearly 40%.  In view of the current HIV/AIDS prevalence rates improved hygiene practices and access to safe water and sanitation facilities also reduce the chance of infection with opportunistic diseases (diseases which attack the body due to weakened immunity) such as diarrhoea and tuberculosis.   

In addition, greater access to improved water and sanitation services and improvement in personal hygiene behaviour may confer other benefits. These include averted health-related costs, avoidance of time lost from daily activities as a result of illness, and time saved by having water and sanitation closer to home. Time saved may translate into higher productivity and higher school attendance. 

The Grim Situation in East Africa

In Kenya, it is estimated that 38% of the population have no access to adequate and safe water supply and 52% lacks access to adequate and appropriate sanitation, (UNICEF 2006). A rapid applied research pilot study to determine the level of hygiene awareness conducted in Korogocho slums of Nairobi in Kenya by NETWAS Kenya and Water Supply and Sanitation Collaborative Council in 2003 indicated that knowledge on the key hygiene behaviours and practices by the slum residents was very low and only 29% of the respondents had ever attended any form of hygiene training (NETWAS 2003)4

In Uganda, developments in hygiene and sanitation have dragged behind in the water sub sector which has blunted the impact of water and sanitation projects. The traditional approach has focused mainly on improving water supplies.  Consequently, 80% of incidences of diseases in Uganda are linked to poor sanitation, (WaterAid, 2006).

Despite its importance in achieving better health, water and sanitation coverage has been low in East Africa especially in the rural areas. Major efforts to address this problem have been concentrated on urban slum dwellers and less to informal rural settlements.

The Challenge in East Africa

Provision of water and sanitation facilities is necessary but not sufficient for sustainability of hygiene behaviour changes. A lot of emphasis in East Africa in the recent past has been placed on provision of the hardware component without necessarily providing the software. Case studies in Kenya and Uganda carried out by Water Aid have identified key determinants to sustainable adoption of hygiene behaviours such as:

  • making hygiene and sanitation programmes an integral part of water supply interventions

  • targeting children, using tailor-made hygiene promotion programmes, ideally in schools.

Therefore, there is need to shift the focus and integrate hygiene awareness and education programmes to influence behaviour change.

In an effort to address part of this challenge, school sanitation and hygiene education activities have been initiated in several parts of Kenya to influence hygiene practices among pupils, teachers and parents using child to child as well as child to parent approaches.   

A Water, Sanitation and Hygiene (WASH) campaign was launched in Kenya in 2002 aiming at, among other things, promoting hygiene awareness. This targeted key behaviors such as hand washing after using toilets and before handling food as well as latrine use and maintenance at home and in schools.

Approaches applied

In Kenya, Uganda and Tanzania, the Participatory Hygiene and Sanitation Transformation (PHAST) approach to water and sanitation projects has been adopted to promote hygiene and sanitation improvements, and community management of water and sanitation facilities. PHAST was introduced in the understanding that hygiene behaviours are particularly difficult to change because they relate to daily activities, they are shared by the whole community and they form part of the culture and traditions of the community. This is addressed by involving community groups in discovering the routes of water-borne diseases, analyzing their own behaviours in light of this information and then planning how to block contamination routes. PHAST also facilitates communities in deciding what they want from hygiene and sanitation projects, how these should be set up and paid for and how to ensure sustainability.  

Another approach adopted in East Africa (Kenya and Uganda) to promote safe hygiene practices is the Personal Hygiene and Sanitation Education (PHASE), which targets school children. It aims to reduce diarrhoeal diseases linked to poor hygiene and to improve children’s overall health and wellbeing by providing guidance on the importance of hand washing and other hygiene practices.  

A multi-country study on sustainability of hygiene behaviour involving selected countries in Asia and Africa including Kenya, indicates that intensive hygiene promotion interventions, such as working with small groups and through personal contact, will have tangible and sustained impact on people’s  behaviour, (Cairncross S., Shordt K. 2004). The study further concludes that sustainability of the desired behaviour is possible when hygiene is highly prioritized and adequate resources are committed to hygiene promotion.  

Scaling up and increasing the effectiveness of investments in sanitation need to be accelerated to meet the ambitious Millennium Development Goals.


  1. Key WaterAid Facts. Available at: 

  2. WHO, Burden of Disease and cost-effectiveness estimates.  Available at: 

  3. (UNICEF 2006) issues facing children in Kenya 

  4. Ghosh G. (WSSCC), Karanja B. (2003). Water, Sanitation and Hygiene for All, The WASH Campaign in Kenya, NETWAS. Available at: 

  5. Sustainable hygiene behaviour change, a study of key determinants. Available at: 

  6. GlaxoSmithKline (2006). PHASE - Helping children to help themselves and each other.  Available at: 

  7. Cairncoss S., Shordt K. (2004). It does last! Some findings from a multi-country study of hygiene sustainability. Waterlines 2004; 22:4-7


This Regional Annex was developed by Gerald Rukunga, AMREF Kenya (2004) under the WELL Partnership.  For further information contact:  



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