The state of handwashing with soap Dr Val Curtis

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Towards universal handwashing with soap: Annual Review 2008/09
The state of
handwashing with soap
Dr Val Curtis
Top 10
Hygiene Lessons
Changing behaviour
of 1 billion people
by 2015
Lifebuoy way of life
Annual Review 2008 - 2009
{
LIFEBUOY’S
ON A MISSION
02
Lifebuoy aims to bring safety, security
and health to five billion people around
the world, through the active promotion
of handwashing with soap.
03
Lifebuoy way of life
Annual Review 2008 - 2009
Contents
6
Foreword
- Opening statements from Paul Polman, Unilever CEO,
and Ricardo Pimenta, Global Brand VP Unilever Health Brands
8
Our commitment to making a difference every day
- Myriam Sidibe, Lifebuoy Global Social Mission Manager,
introduces the Lifebuoy Social Mission
10
Lifebuoy - in brief
- Some facts about the brand
12
Handwashing state of the world
- A summary from Dr Val Curtis, Director of the Hygiene Centre at the
London School of Hygiene & Tropical Medicine
14
A brand on a mission
- Making a difference around the world
16
Hygiene promotion activations
- Putting a spotlight on Lifebuoy country programmes
20
Capacity building and partnerships
- How teamwork is shaping the future for handwashing
24
Advocacy
- Keeping handwashing on the global and local agendas
28
Lifebuoy Way of Life
- Tracking social and business impacts
30
Rewind and Recap
- The Lifebuoy Top 10 hygiene and health lessons
learned from 2008-2009
32
Our next steps
- Anuj Rustagi, Lifebuoy Global Brand Director,
outlines the Lifebuoy Way of Life Challenge
33
04
References
05
Lifebuoy way of life
POSITIVE
“I sincerely believe that businesses like
Unilever can be a positive force for good
in the world and that such an approach is
in the interests of all our stakeholders – our
investors, our consumers, our employees
and the communities where we operate.”
Foreword
{
Unilever’s mission is to meet the
everyday needs of people around
the world for nutrition, hygiene
and personal care. We do this with
products that help people feel good,
look good and get more out of life –
something which Lifebuoy has been
doing for the past 114 years.
Every day around 160 million people
in 150 countries choose our Unilever
brands to feed their families and to
clean themselves and their homes.
And every second, 91 families
choose a Lifebuoy product to deliver
on health and hygiene promises.
Unsurprisingly, therefore, the social
and environmental impacts we have
on the world come largely from our
brands, and Lifebuoy is at the centre
of the positive social impacts that
Unilever as a corporation can deliver.
This is why we are embedding
sustainability thinking into the
day-to-day activities of our brand
management and R&D teams. The
Lifebuoy brand has been at the
forefront of the piloting of tools such
as Brand Imprint and social metrics.
Both these tools are helping us think
more carefully about the resources
06
{
Annual Review 2008 - 2009
Paul Polman,
Unilever Chief
Executive
Officer
Foreword from Ricardo Pimenta,
Global Brand Vice President,
Unilever Health Brands
we use, such as water, packaging,
energy and raw materials, and the
social and economic impacts of our
brands in the countries where they
are sold.
growth every year in recent years,
demonstrating its ability to offer an
invaluable response to the demands
of consumers in developing and
emerging markets.
Ever since the launch of its first
soap products over 100 years ago,
Lifebuoy has helped make a positive
difference to people’s health and
well-being in the developed and
developing world. But preventable
diseases, resulting from poor hygiene
and sanitation, still pose a significant
health challenge. Every year more
than 3.5 million children still die
before the age of five because of
diarrhoea and acute respiratory
infections. Encouraging people to
change their habits – by washing
hands with soap before touching
food and after going to the toilet – is
essential, and central to all Lifebuoy
brand activities.
This first Lifebuoy Social Mission
Annual Review is evidence of
how seriously Lifebuoy takes its
commitments. The report provides
a review of our latest activities to
support the Lifebuoy social mission –
a mission that is absolutely integral
to the brand.
What makes doing good sustainable
in the long run is the business
benefits that Lifebuoy delivers year
after year. It is one of the fastestgrowing brands in our skin care
business, recording double digit
07
Lifebuoy way of life
Annual Review 2008 - 2009
Our commitment to
making a difference
every day
By Dr Myriam Sidibe DrPH, Lifebuoy Global Social Mission Manager
THE LIFEBUOY BRAND’S SOCIAL MISSION IS TO BRING SAFETY, SECURITY
AND HEALTH TO FIVE BILLION PEOPLE THROUGH THE ACTIVE PROMOTION
OF HANDWASHING WITH SOAP. AND WHILE OUR PRODUCTS ALREADY
PROVIDE MILLIONS OF PEOPLE WITH ACCESSIBLE AND AFFORDABLE
HYGIENE, AS THE WORLD’S LEADING HEALTH SOAP, WE KNOW THERE IS
MORE THE BRAND CAN DO.
Through the Lifebuoy brand’s social mission
programmes we aim to make a difference in
people’s day-to-day lives – spreading positive
hygiene messages through hygiene promotion
activities. The projects instigated by our country
teams are already making a difference and
helping to save lives. The resources we provide
to complement those supplied by the public
sector are vital to ensure that we continue
reaching people who need our help the most.
Our commitment to the Lifebuoy social mission
is evident in the steps we have taken towards
making handwashing with soap central to the
brand’s marketing efforts.
This report gives an overview of the work
Lifebuoy has done in 2008 and 2009, partnering
Lifebuoy together with public and private sector
partners around the world, who share the brand’s
commitment to promoting health and hygiene.
Without these important partnerships it would not
be possible to share our messages on such a
large scale.
Before joining the Lifebuoy team, I worked for
non-governmental organisations and in the
public sector, and have lived in more than 20
countries around the world. I sought a platform
from which I could make a real impact to people’s
lives. I believe that Lifebuoy and Unilever as a
corporation offers this platform, with clear, tangible
deliverables that are relevant both for business
and social benefits. Visiting some of the Lifebuoy
brand’s social mission programmes in India,
Indonesia and Vietnam has made me realise that
we have already achieved so much, thanks to the
right support and gives me the confidence that we
can achieve a lot more. The commitment of our
Lifebuoy teams across the world is exceptional
and unique.
08
I AM CONFIDENT THAT THE LIFEBUOY TEAMS, TOGETHER WITH
OUR PARTNERS, CAN CONTINUE TO BUILD ON OUR WORK IN
THE FUTURE, TO MAKE A LASTING IMPACT ON PUBLIC HEALTH
AROUND THE WORLD.
Key:
Countries where Lifebuoy was sold in 2009
09
Lifebuoy way of life
Annual Review 2008 - 2009
LIFEBUOY • L AUNCHED IN THE UK IN 1894, Lifebuoy is one of Unilever’s oldest
• The Lifebuoy Clinical Trial in 2007/8 demonstrated that by following
brands, and has championed a message of health through hygiene for
the Lifebuoy Way (washing hands at 5 key occasions during the day),
more than a century
episodes of diarrhoea in target children reduced by 25% and target
children had 40% less days off school due to illness, compared with the
• One of Unilever’s founders, William Lever, launched the Lifebuoy brand
control group.
to help bring affordable hygiene to Victorian England at a time when
epidemics of typhoid, smallpox, cholera and diphtheria were a
constant threat.
• Lifebuoy branded hygiene promotion activations, such as Swasthya
Chetna in India, Berbagi Sehat in Indonesia and Germ Fighters in Sri
Lanka have educated over 125 million people about the importance of
• Today Lifebuoy products are sold in more than 34 countries in Asia and
handwashing with soap.
Africa, and every second 91 families buy a Lifebuoy product, trusting
the Lifebuoy brand for their family’s health.
* ACNielsen Scantrack and Retail Index Skin Cleansing Brand Volume Sales 12 months to August 2009
• Lifebuoy was the world’s first health soap when it was launched in 1894,
and it is still the world’s no.1 selling germ protection soap today*.
10
11
Lifebuoy way of life
Annual Review 2008 - 2009
Handwashing
state of the World
A report from Dr Val Curtis, Director of the Hygiene Centre at the
London School of Hygiene & Tropical Medicine
AVERAGE CHILD DEVELOPMENT
THE GRAPH ON THE RIGHT TELLS
A VERY SHORT LIFE STORY. IT
BEGINS WITH LAXMI’S BIRTH, IN
A VILLAGE IN RURAL ANDHRA
PRADESH ON THE SOUTH-EASTERN
COAST OF INDIA. A HAPPY CHILD,
LAXMI GROWS WELL UNTIL HER
FIFTH MONTH WHEN SHE FALLS
ILL WITH DIARRHOEA AND A BAD
COUGH. SHE RECOVERS BUT AT NINE
MONTHS CATCHES A RESPIRATORY
INFECTION THAT TURNS INTO
PNEUMONIA.
Though it takes her family a while to gather together
the money for medicine, she is eventually cured. But
because of repeated diarrhoea and respiratory illnesses,
Laxmi is malnourished, leaving her vulnerable to
infections.
BY THE AGE OF THREE SHE IS SO WEAK
AFTER SUFFERING FROM MEASLES THAT
AN INFECTION THAT IS NEVER EVEN
DIAGNOSED CAUSES HER DEATH.
Laxmi’s is not an unusual story. Every year in developing
countries more than 10 million children die before their
fifth birthday1. But there is some good news. Child
survival has been improving in recent decades due to
better health care, continued economic development,
improved products and environments, and new cultural
expectations.
However, there’s still a long way to go. While most
people in emerging markets do have soap at home,
more than 80% fail to use it for washing their hands. As
a result, children face an onslaught of pathogens every
day in their own homes.
HANDWASHING HELPS:
THE LATEST FINDINGS
It is a well known fact that effective handwashing can
prevent diarrhoeal diseases. Handwashing with soap is
12
LAXMI’S DEVELOPMENT
thought to reduce diarrhoea risk by up to 50%2-4. And in
the last few years we have learned that handwashing
can do even more. It protects from respiratory infection,
reducing risk by an estimated 23%5 and a study in
Pakistan saw handwashing halve the risk of pneumonia
infections6. It protects against pandemic flu7, SARS8,
trachoma9, and parasitic worm infections10. It keeps
children in school11 and it can reduce the deaths of
newborn babies, according to a recent study from
Nepal12. Research has shown AIDS patients also have
significantly less diarrhoea when they wash their hands
regularly13, and a new study published this year in
the Lancet suggests that poor hygiene may be one of
the reasons for chronic and intractable malnutrition in
developing countries14.
CHANGING BEHAVIOUR
A recent review by the World Bank suggests promoting
handwashing with soap may also be the single
cheapest health intervention there is, coming above
malaria and HIV control in terms of health benefits
against expenditure15.
WHO’S FIGHTING FOR HANDWASHING?
Yet, even in developed countries with taps and towels,
handwashing isn’t the rule. We monitored a motorway
service station in the UK and found that of the 330,000+
people who used the toilets only 32% of men and 64%
of women washed their hands with soap. There is a
long way to go until handwashing with soap becomes a
universal habit.
• The Global Public Private Partnership for Handwashing
with Soap shows people around the world that
handwashing with soap is important and that it can
be promoted in exciting new ways. It has also helped
establish Global Handwashing Day, which has had a
huge impact worldwide
• The Clean Care is Safe Care programme has been
rolled out by the World Health Organisation to
Handwashing behaviour is learned early in life, is highly
habitual, and is influenced by local cultural norms16 – so
by what everyone else is doing. Given the difficulty of
shifting established habits, we’ve found that we need
to use shock tactics to make an impact.
One approach that has been shown to work is to
disgust people, making them aware that there
is something nasty on their hands, by using a
demonstration kit or through advertising17-19. Since
people copy what others do it’s important to promote
the idea that everybody is doing it20. Public pledges to
handwash are likely to work, as are visible badges on
young people or on houses or public walls.
After many years working to raise the profile of
handwashing, it’s finally getting global recognition. Key
initiatives include the following:
encourage handwashing in health care facilities
around the world, achieving recognition despite
modest levels of funding
• International programmes to promote hygiene in
schools are also ongoing, many supported by UNICEF.
These can have a major impact on young people’s
behaviour, but we still need to do more work to find
out which approaches work best with children
• Agencies that promote safe water and sanitation
including UNICEF, the UK Department for
International Development, WaterAid, Oxfam and
non-governmental organisations all over the world
generally agree that the promotion of hygiene is an
essential adjunct to their work. However, it is hard
to run effective behaviour-change programmes,
especially when hygiene is always under-resourced.
•G
overnments worldwide are taking up the
handwashing message, mostly in response to
pandemics such as SARS, bird flu and swine flu. They
still have to learn that handwashing is for life, not just
for emergencies.
SO WHAT CAN WE DO?
The private sector has a key role to play in handwashing. Soap marketers,
such as those working on Lifebuoy, know what changes behaviour and
understand how to design and deliver campaigns that reach vast and
diverse populations. Marketers are masters at consumer insight, at creative
design and at the rollout and management of big campaigns21. Those of
us working in the health sector are depending on soap companies to work
with us to help deliver handwashing to the millions that need it.
HANDWASHING CAN HELP PREVENT:
Diarrhoea
Trachoma
Sickness in AIDS Patients
Pneumonia
Worm infection
Chronic malnutrition
Swine flu
Neonatal mortality
SARS
School absenteeism
13
Lifebuoy way of life
Annual Review 2008 - 2009
YGIENE PROMOTION
H
ACTIVATIONS
A brand
on a mission
1
THROUGH LIFEBUOY, WE AIM TO MAKE A DIFFERENCE IN PEOPLE’S
DAY-TO-DAY LIVES. WORKING WITH PUBLIC AND PRIVATE
SECTOR PARTNERS AROUND THE WORLD, OUR CHALLENGE IS TO
TRANSFORM HANDWASHING WITH SOAP FROM AN ABSTRACT
GOOD IDEA INTO AN AUTOMATIC BEHAVIOURAL PATTERN AT
CRITICAL TIMES OF THE DAY.
Around the world, Lifebuoy handwashing initiatives
and hygiene promotion programmes reach people
where they live, work and play – in villages, schools,
shopping malls and hospitals.
To ensure that our messages make a difference,
we find ways to engage communities, ensuring
that consumers understand the important role that
handwashing with soap plays in keeping people safe
and healthy. Central to this is the need for our target
audience to experience effective handwashing to
instil good habits.
C APACITY BUILDING
AND PARTNERSHIPS
OUR SOCIAL MISSION ACTIVITIES
ARE BUILT UPON THE FOLLOWING
THREE BELIEFS:
2
• THE WORLD HAS MOVED ON FROM
PHILANTHROPY.
We realise donations alone cannot not provide the
sustained, continuous programme of support that the
world’s most intractable problems – such as improving
health and hygiene – normally require
• WE BELIEVE THAT BRANDS CAN BE A
POSITIVE FORCE FOR GOOD.
This is deep-rooted in the Lifebuoy brand history and
Unilever’s ongoing commitment to social responsibility.
We seek to invest in changing behaviour sustainably
• THE FUTURE LIES WITH PUBLIC AND
PRIVATE SECTOR PARTNERSHIPS.
The private sector is best placed to provide expertise
on marketing behaviour-change to large audiences,
working with non-governmental organisations
and governments to help achieve the Millennium
Development Goals. These goals are a set of
internationally-agreed targets designed to alleviate
poverty, hunger and ill-health around the world, and
improve education, gender equality and environmental
sustainability through global partnerships by 2015.
14
>See page 16
THE LIFEBUOY
SOCIAL MISSION
ACTIVITIES INVOLVE
SPREADING POSITIVE
HYGIENE MESSAGES
THROUGH EDUCATION.
OUR ACTIVITIES
FOCUS ON THREE
CORE AREAS:
The Lifebuoy brand team partners public and private
sector organisations around the world which share
our commitment to promoting health and hygiene. By
sharing our skills and experiences with our partners
through activities and education campaigns, we can
help build expertise in communicating the importance
of handwashing with soap – a task which is too big
for any single organisation to tackle alone.
>See page 22
ADVOCACY
3
It is important to raise the profile of
handwashing with soap, creating the right
environment for investment in behaviourchange activities. Lifebuoy branded advocacy
activities in 2008/2009 included addressing
delegates at events such as the World Health
Organisation Child Environmental Health
conferences and the What If! Sustainable
Development Conference. The brand also
became a founding partner of Global
Handwashing Day in October 2008.
>See page 26
15
Lifebuoy way of life
1
Annual Review 2008 - 2009
Lifebuoy’s
hygiene
promotion
activations
GLOW-GERM EXPERIENCE
A SIMPLE, LOW-COST DEVICE IS HELPING
LIFEBUOY DEMONSTRATE THE CLEANSING
POWER OF SOAP TO COMMUNITIES
ACROSS THE DEVELOPING WORLD. IN
LINE WITH THE BRAND’S COMMITMENT
TO MAKING ITS ACTIVATIONS
INTERACTIVE AND ENGAGING AS WELL AS
EDUCATIONAL, WE CAME UP WITH THE
GLOW-GERM EXPERIENCE.
ENCOURAGING HANDWASHING BEHAVIOUR CHANGE IS CENTRAL TO
ALL LIFEBUOY ACTIVATIONS. GENERALLY PEOPLE WASH THEIR HANDS
SPORADICALLY WHEN THEY ARE ABOUT TO COME INTO CONTACT WITH
FOOD OR AFTER USING THE TOILET. SOAP ONLY TENDS TO BE USED WHEN
HANDS ARE VISIBLY DIRTY, SMELLY OR FEEL STICKY OR UNPLEASANT.
It all starts with a basic black box, which we source
locally in the countries where activations are set to take
place. The box is then fitted with an ultra-violet (UV)
bulb.
At Lifebuoy-branded demonstrations, consumers are
given a special UV powder to rub into their hands, which
By reviewing existing knowledge and
insight, teams working on Lifebuoy have
identified key behavioural issues which
we address in our campaigns to drive
sustainable handwashing behaviour change
and which have helped us define the tools
necessary to achieve such change.
Featured in this report is a selection of case
studies highlighting some of the hygiene
promotion activations initiated by Lifebuoy
and supported by the brand’s advertising
and promotion budget.
they then rinse with nothing but water. Their hands
appear clean to the naked eye but when placed under
UV light, traces of the powder are revealed, highlighting
how germs can remain on the skin despite hands
looking clean.
Consumers are then invited to wash their hands with
Lifebuoy soap before placing them inside the box
again. This time, no signs of the UV powder can be
seen – providing a powerful emotional reminder that
LIFEBUOY HYGIENE PROMOTION ACTIVITIES ADHERE
TO THE FOLLOWING GUIDING PRINCIPLES:
handwashing with soap provides greater protection
against germs than washing with water alone.
• Activities educate through experience, demonstrating the importance of
handwashing with soap and how this should be done
• Lifebuoy is a family ally. It’s a vitality brand, helping families to stay healthy and
active for life, in line with Unilever’s global vitality mission
• Activities should include parents and children together, to foster lasting good habits
in handwashing.
16
17
Lifebuoy way of life
Annual Review 2008 - 2009
SPOTLIGHT: Swasthya Chetna, India
1
hygiene
promotion
activations
THE LIFEBUOY SWASTHYA CHETNA PROGRAMME, TRANSLATED AS HEALTH AWAKENING, LAUNCHED
IN 2002 AS A RURAL HEALTH AND HYGIENE INITIATIVE IN INDIA, A COUNTRY WHERE MORE THAN
600,000 CHILDREN UNDER THE AGE OF FIVE DIE EACH YEAR FROM DIARRHOEA.
Continued
Activity:
Reach:
In partnership with local government bodies, the
Swasthya Chetna programme continues to raise
awareness about the importance of handwashing
with soap to prevent disease, with the central
message ‘Visibly clean is not really clean’. Lifebuoy
teams visit each village involved in the programme
three times, at a total cost of US$30 per village.
Activities involve schoolchildren, parents and the
wider village community.
By the end of 2008, the Swasthya Chetna
programme had reached more than 120 million
people in 50,600 rural villages, making it the
single largest private hygiene education project in
the world, with investment of over US$5 million
from Hindustan Unilever Ltd.
SPOTLIGHT: Germ Fighters, Sri Lanka
THE LIFEBUOY GERM FIGHTERS CAMPAIGN STARTED IN SRI
LANKA IN 2002, TO EDUCATE CHILDREN AND THEIR PARENTS
ABOUT THE IMPORTANCE OF GOOD HYGIENE HABITS.
SPOTLIGHT: Berbagi Sehat, Indonesia
A NATIONAL HEALTH SURVEY UNDERTAKEN PRIOR TO THE LAUNCH OF LIFEBUOY BERBAGI SEHAT
HYGIENE EDUCATION PROGRAMME IN 2004 INDICATED THAT A HIGH PROPORTION OF PEOPLE IN
INDONESIA NEGLECTED TO WASH THEIR HANDS WITH SOAP AT CRITICAL TIMES. THIS WAS DESPITE
FIGURES REVEALING ALMOST 100% OF HOUSEHOLDS IN THE COUNTRY PURCHASED SOAP.
Activity:
Reach:
Working with an extensive network of partners
including national and local government
departments, non-governmental organisations,
retailers and the media, the Lifebuoy Berbagi
Sehat programme aims to help with hygiene
infrastructure improvements and educate
school children, and their mothers, to instil
healthy hygiene habits. The three strands of
the programme cover access to hardware (ie
handwashing facilities and toilets), enabling
hygiene environments and hygiene promotion.
The programme has expanded both geographically
and in scope each year since its launch. Growing
numbers of school teachers and community
workers have also been used as hygiene
champions to multiply the impact of the
programme in communities. By the end of 2008,
Berbagi Sehat had reached more than 1.1 million
people, with investment of over US$600,000
from Unilever Indonesia (excluding media spend).
Research carried out following one of the Lifebuoy
brand’s interventions reported that 84% of people
who had been involved with the campaign
subsequently washed their hands with soap after
using the toilet, compared to 58% in the
control group.
18
Activity:
Reach:
Working with the Sri Lankan Ministry of
Health, schools and local communities,
each Germ Fighters school programme
involves different activities to raise
awareness of handwashing with soap. Art
competitions, essay writing contests and
drama productions, along with handson handwashing experiences ensure
schoolchildren are engaged. Health and
hygiene standards in participating schools
are upgraded, with new toilets and water
pipeline systems, and community clean-up
activities organised.
By the end of 2008, the Germ Fighters
programme had reached over 500,000 school
children in over 500 schools. In every region
where the programme has been activated,
soap consumption has increased when
measured 2-3 months following the activity,
indicating that Germ Fighters has had an
impact in changing household behaviour with
regards to washing with soap.
SPOTLIGHT:
Mahfooz, Pakistan
THE
LIFEBUOY
MAHFOOZ
PROGRAMME LAUNCHED IN
PAKISTAN IN 2005, WITH THE
GOAL OF PROVIDING HYGIENE
EDUCATION TO PEOPLE IN
RURAL COMMUNITIES.
Activity:
The Mahfooz programme reaches out to rural
households and schools. As part of the campaign,
groups of women have been invited to houses
in their neighbourhood and provided with
information about the importance of handwashing
with soap. In schools, themed Germ Buster
assemblies have taken place, with bandanas and
soap products distributed to help reinforce the
hand hygiene message.
Reach:
By the end of 2008, the Mahfooz programme had
reached more than 100,000 households directly.
19
Lifebuoy way of life
Annual Review 2008 - 2009
SPOTLIGHT:
Lifebuoy responds to swine flu
ONLY WEEKS AFTER THE FIRST CASES OF THE INFLUENZA
A H1N1 VIRUS, COMMONLY KNOWN AS SWINE FLU,
WERE DIAGNOSED IN MEXICO IN EARLY 2009, THE VIRUS
HAD SPREAD TO MORE THAN 76 COUNTRIES. GIVEN
ITS WIDESPREAD GLOBAL REACH, THE WORLD HEALTH
ORGANISATION DECLARED H1N1 A GLOBAL PANDEMIC,
WITH THE GOAL THAT RECOMMENDED PREVENTATIVE
ACTIONS WOULD HELP TO REDUCE THE IMPACT OF THE
PANDEMIC ON SOCIETY.
LIFEBUOY IS UNIQUELY POSITIONED TO PLAY A KEY ROLE
AT TIMES OF SUCH HEALTH CRISES. THE LIFEBUOY BRAND
MISSION STATES ITS COMMITMENT TO IMPROVING
HEALTH AND HYGIENE, AND SAVING LIVES THROUGH
HANDWASHING. THE RESPONSE BY LIFEBUOY TEAMS
DURING THE GLOBAL PANDEMIC HAS PROVIDED THE
OPPORTUNITY FOR LIFEBUOY TO LIVE UP TO THIS
MISSION.
1
Activity:
hygiene
promotion
activations
Continued
SPOTLIGHT: Vietnam’s future in millions of clean hands
Activity:
THE
LIFEBUOY
BRANDED
HYGIENE
PROMOTION PROGRAMME IN VIETNAM
STARTED IN 2008, AND AIMS TO CHANGE
THE HANDWASHING HABITS OF 62 MILLION
RURAL CONSUMERS TO REDUCE THE NUMBER
OF CHILD DEATHS CAUSED BY DIARRHOEA IN
THE COUNTRY EACH YEAR.
20
In partnership with Vietnam’s Women’s Union, the initiative draws on many of
the elements from the Lifebuoy Swasthya Chetna programme. The programme
is taken to women’s groups and primary schools educating them, through the
use of activities such as the glow germ demonstration, that ‘Visibly clean is not
really clean’. In a 2007 Ministry of Health survey, while 70% of respondents
in Vietnam understood the need to wash hands with soap before eating, only
6.1% did it in practice. The programme activities seek to change these habits.
Lifebuoy developed a complete
influenza pandemic response package,
with resources made freely available
through the Lifebuoy.com website.
Information was also deployed during
the first wave of the pandemic across
a variety of media channels, including
TV, press, radio, instore and schools
in all Lifebuoy geographies where
swine flu had been detected. The
key message during the pandemic’s
initial phase was ‘Washing hands
frequently with soap is one of the
simplest and most effective ways to
prevent swine flu – issued in the public
interest by Lifebuoy’. To minimise any
confusion for the public, and maximise
consumer reach, wherever possible
Lifebuoy teams worked directly with
local Ministries of Health, broadcasting
combined public service messages.
Reach:
During the first wave of the pandemic,
the Lifebuoy Swine Flu response
package was deployed across all
key Lifebuoy geographies, including
India, Sri Lanka, Cambodia, Indonesia,
Malaysia, Singapore and Vietnam.
Reach:
The programme was piloted in a single province in 2008, and in 2009 was rolled
out to the whole of the Mekong Delta region, comprising 13 provinces and
covering approximately 1,200 communes and 400,000 people.
21
Lifebuoy way of life
Annual Review 2008 - 2009
2
C apacity
building and
partnerships
REACHING FIVE BILLION PEOPLE EFFECTIVELY WITH
A HANDWASHING MESSAGE THAT WILL DRIVE
BEHAVIOUR CHANGE IS NOT SOMETHING THE LIFEBUOY
BRAND CAN DO ALONE. THEREFORE THE NEED FOR
PARTNERS WHO SHARE OUR VISION AND GOALS IS KEY
TO IMPLEMENTING THE BRAND’S SOCIAL MISSION.
Through the Lifebuoy brand’s 114-year heritage of running
hygiene promotion programmes we have built valuable
hygiene marketing skills. In order to share our knowledge
and skills with public sector partners, we have developed a
capacity building programme so that by working together our
campaigns can have a greater impact in promoting positive
behaviour change.
Our capacity building initiatives adhere
to the following key principles:
Lifebuoy Social Mission Stewardship –
Building in-house capacity
• We will share our expertise based on evidence that our
programmes are effective
On 18 November 2009, more than 150 people working with Lifebuoy
in 21 countries took part in a unique online event, informing them
about all aspects of the Lifebuoy Way of Life. . They received training
on the key principles of handwashing, learnt how to work effectively
with partners and how to deploy higher implementation standards of
handwashing activities.
• We understand the need for local partners to own their
campaigns. As a result the outputs of our training and capacity
building are locally owned campaigns, into which public bodies
can invest their own resources
• We recognise that we can learn skills from the public sector and it
is important that the capacity building angle is a dual process.
We believe it is vital for Lifebuoy brand teams to partner with
local and national governments to take the vision of universal
handwashing forward. The more people hear about the benefits of
handwashing with soap from varied sources, the better chance we
have to establish social norms around handwashing.
The aim of this event was to ensure that people working with the
Lifebuoy brand fully understand the importance of handwashing with
soap, and feel motivated and inspired about the Lifebuoy brand’s social
mission. A Lifebuoy Handwashing Master Class was developed and
made mandatory for all working on Lifebuoy.
Welcome to the
Handwashing
Master Class
Start
Online Learning Module
UNILEVER LIFEBUOY – STEERING COMMITTEE MEMBER OF THE PUBLIC
PRIVATE PARTNERSHIP FOR HANDWASHING.
The Public Private Partnership for Handwashing was initiated in 2002 (see
http://www.globalhandwashing.org) and is a collaboration between
several organisations such as several organisations including Unilever,
Procter & Gamble, UNICEF, Colgate, USAID and the London School of Hygiene
and Tropical Medicine, with the aim to promote handwashing with soap.
22
23
Lifebuoy way of life
Annual Review 2008 - 2009
PROJECT CHAMPION:
ENCOURAGING HANDWASHING
BEHAVIOUR AT SCALE THROUGH AN
ONGOING PARTNERSHIP BETWEEN
UNILEVER AND UNICEF
2
Continued
The opportunity:
Project Champion’s mission is to make a contribution
to Millennium Development Goal Four – reducing
child mortality. We’re working with UNICEF to do
this by designing, testing, packaging and making
available an approach to encourage the habit of
handwashing with soap among caregivers for the
under-fives in poor communities in developing
countries. The campaign focuses on making schoolaged children a key route of influence into homes.
The biggest challenge faced by national
handwashing campaigns is getting people to adopt
handwashing with soap as a permanent habit,
and few public sector officials responsible for such
campaigns have experience of developing effective
behaviour-change communication techniques. By
providing marketing training to such professionals
and sharing Unilever’s experience in driving
behaviour change, we see an opportunity
to significantly increase the effectiveness of
handwashing behaviour-change campaigns.
Phase one of Project Champion was completed in
late 2008, examining two key hypotheses. The first
was that the project should take a global approach
– a theory which was validated by desk research,
expert interviews and literature reviews. The second
hypothesis was that children could play a key role in
influencing adult behaviour at home. We carried out
a proof of principle study in rural Uganda to test this,
with encouraging results. Within the public health
sector children are often seen as agents of change,
but this was the first study that actually measured
the impact children have on health at home.
Our achievements to date
and next steps:
Findings from Phase one of Project Champion support
the case for a global approach to encourage the habit
of handwashing with soap in poor communities in
developing countries. We believe a global approach
to this initiative is valid, but marketing will need
to be tailored to suit the different and diverse
communities in which Lifebuoy has a presence.
Our research also offered direct evidence that
children can influence more than just attitudes
among the adults that care for them at home,
helping to foster lasting good habits in handwashing.
Older girls are the most influential audience for this
project, with two key behaviour-change catalysts
having the biggest impact: handwashing with
soap as a social norm, and the feeling of disgust at
unclean hands. We’re certain that through education,
older children can become valuable messengers of
change in this vital area.
Unilever-UNICEF partnership
24
THE IN SAFE HANDS PROGRAMME IS ONE OF THE MOST
SIGNIFICANT PRIVATE SECTOR CONTRIBUTIONS TO THE PUBLIC
PRIVATE PARTNERSHIP FOR HANDWASHING WITH SOAP.
The opportunity:
Project activities:
C apacity
building and
partnerships
In Safe Hands:
SharIng marketing expertise with the public sector
Programme activity:
In Safe Hands was designed by Unilever’s
Marketing Academy and the Lifebuoy brand
team, and has been implemented successfully in
Vietnam, Kenya, Tanzania, Uganda and Indonesia.
Through the programme, senior decision makers
and policy formers are educated on the role
and value of marketing in achieving behaviour
change, including taking part in live consumer
immersion exercises to see how effective
marketing activations can really make an impact
on communities. Upon completion of the training,
Unilever teams support public sector organisations
to develop real-life handwashing campaign
communications.
Our achievements to date:
More than 300 public sector professionals have
taken part in the In Safe Hands programme.
As a result, several Lifebuoy-backed national
handwashing campaigns are now at various stages
of development:
• In Uganda and Tanzania, a ‘Hands to be proud
of’ campaign is being rolled out, tailored for
each country to suit the local context. Over
US$700,000 has been raised to run the campaign.
• In Kenya a national taskforce to promote
handwashing with soap has been established,
led by the Ministry of Public Health and
Sanitation, and supported by partners including
UNICEF, Water & Sanitation Programme Africa,
PLAN International and CARE. A communication
campaign is currently in development, and the
Kenya team is aiming to raise over US$800,000 to
run the campaign.
Deby Sadrach, Vice
President Home & Personal
Care Unilever Indonesia,
officially opened the Health
Expo preceding the In
Safe Hands Workshop in
Indonesia.
“The Lifebuoy brand has a social mission that
has been deeply embedded in the brand
ever since it was launched in Indonesia.
Through the brand’s involvement in the
public-private partnership activities and by
sharing our marketing expertise, Unilever
gets excellent opportunities to enhance the
Lifebuoy brand’s social impact for positive
behaviour change in the country. Going
forward, we are committed to continue doing
this, and widen further the impact towards
more and more Indonesian families”. Chris Nsubbugga,
Handwash Coordinator,
Water & Sanitation
Programme Africa,
received In Safe Hands
training:
“Since taking part in the In Safe Hands
programme, we have found a common
campaign idea to promote handwashing with
soap in the East Africa region – ‘Hands to be
proud of’. It’s a great concept and we would
never have reached this stage without the
support from In Safe Hands and the Lifebuoy
brand. I found the immersion exercise during
the workshop really useful. Being able to go
out into the community, talk to consumers
and understand their needs enables us to
find out so much about them.”
• In Indonesia, the Public Private Partnership
for Handwashing with Soap has requested
Lifebuoy’s support in developing an effective
communication campaign. The communication
brief is currently being drafted.
25
Lifebuoy way of life
Annual Review 2008 - 2009
GLOBAL HANDWASHING DAY
Launched in 2008, Global Handwashing Day is
an annual event backed by the Public Private
Partnership for Handwashing with Soap, of
which Unilever, through its Lifebuoy brand, is a
founding partner.
THE OPPORTUNITY:
The annual celebration of Global Handwashing
Day is designed to foster and support a global
and local culture of handwashing with soap,
raising awareness of its benefits, and shining a
spotlight on the state of handwashing in each
country taking part.
In the long term, we hope Global Handwashing
Day will become a powerful platform for
advocacy aimed at policy makers and key
stakeholders, and an occasion for public
commitment to action that will instil behaviour
change at scale.
3
PROGRAMME ACTIVITIES:
Advocacy
The Lifebuoy brand works with over 50
partners across the globe to bring the health
and hygiene message to millions of consumers
in countries selling Lifebuoy.
ADVOCACY IS A CENTRAL ELEMENT OF OUR EFFORTS TO PROMOTE GLOBAL HANDWASHING WITH
SOAP BECAUSE IT HELPS TO SET THE RIGHT ENABLING ENVIRONMENT FOR THE HANDWASHING
PROGRAMMES WE SUPPORT, EXTENDING OUR REACH AMONG INFLUENTIAL AUDIENCES AND
SPREADING THE MESSAGE THAT HANDWASHING WITH SOAP CAN BRING MUCH-NEEDED HEALTH
BENEFITS TO COMMUNITIES. WE BELIEVE THAT – THROUGH THE LIFEBUOY BRAND - WE HAVE A
VALUABLE PART TO PLAY IN PROMOTING THE IMPORTANCE OF HANDWASHING WITH SOAP, AND
ALSO HIGHLIGHTING THE ROLE THAT PRIVATE SECTOR PARTNERS CAN PLAY IN THIS AREA.
Although the last decade has seen great
progress in raising handwashing on the
agenda for governments and private sector
organisations, the full benefits of handwashing
with soap are still not appreciated or
understood in many parts of the world. Policies
and programmes on handwashing promotion
are still not widely practised – and that’s an
issue we seek to address.
26
Lifebuoy brand teams are dedicated to
advocating handwashing with soap, and deliver
presentations about our work, research and
goals at high profile meetings and conferences
around the world. As a founding partner of
Global Handwashing Day, the Lifebuoy brand is
helping to raise the profile of the issue to the
whole world.
27
Lifebuoy way of life
Annual Review 2008 - 2009
OUR ACHIEVEMENTS TO DATE
GLOBAL HANDWASHING DAY 2008
The inaugural Global Handwashing Day was
celebrated in more than 75 countries, including
23 Lifebuoy markets.
COUNTRY HIGHLIGHTS IN 2008
GLOBAL HANDWASHING DAY
2009
In 2009, over 85 countries celebrated Global
Handwashing Day including 23 Lifebuoy
markets.
COUNTRY HIGHLIGHTS IN 2009
In South Africa, Lifebuoy brand teams worked
with the Department of Water Affairs (DWAF) to
host a handwashing event as well as organise a
“clean up” of schools across the country.
In Vietnam the Lifebuoy team launched the
global ‘Germ Fighter Drawing Contest’ across
the country and organised a Guinness World
Record attempt.
In Sri Lanka, the Lifebuoy brand teamed up with
government Public Health Inspectors to create a
handwashing pledge for school children. To help
spread the word they travelled around schools
in a Lifebuoy branded bus educating children on
the importance of handwashing with soap.
In Malaysia the Lifebuoy team organised a
month long handwashing campaign which
reached 62,000 children across the country.
In Indonesia, 1,609,000 people participated
in Lifebuoy activities on Global Handwashing
Day. The team generated $284,200 worth of
PR coverage.
In India 15,000 children washed their hands
at the same time to attempt to break the
Guinness World Record. The event was coordinated by the Lifebuoy brand, WHO and the
Indian government.
In Cambodia, Lifebuoy teams organised school
events across the country to generate coverage
in three national newspapers and 4 popular
consumer magazines.
In Uganda, the Public Private Partnership for
Handwashing, UNICEF and the Government
of Uganda joined the Germ Fighter drawing
contest and got 13,000 schools across the
country to participate.
Paul Polman
adressing
Unilever
employees
on Global
Hadwashing
Day
Activities included handwashing pledges
and educating children about handwashing
techniques.
GUINNESS WORLD
RECORD IN BANGLADESH
Lifebuoy teams in Bangladesh worked with
the Department of Public Health Engineering,
UNICEF, the World Health Organisation and
other coalition partners to bring the Global
Handwashing Day message to 75,000 schools
across the country. The activities reached more
than 15 million children, and gained media
coverage from all five national TV channels, 26
national newspapers, and a wealth of regional
publications.
As part of the day’s events, the Lifebuoy
team and its partners broke the Guinness
World Record for the most people washing
their hands with soap at the same time - and
made a significant step towards a long-term
working relationship with Lifebuoy’s partners in
Bangladesh.
2
Advocacy
LIFEBUOY GERM FIGHTER
DRAWING CONTEST
Global Handwashing Day revolves around schools
and children, with activities designed to increase
their participation in handwashing with soap. To
raise awareness of the Global Handwashing Day
campaign and its important hygiene messages
among children, the Lifebuoy team launched its
global ‘Germ Fighter Drawing Contest’ in 2009.
School children aged between 5 and 12 across
many Lifebuoy countries participated.
To date, the Lifebuoy team in Indonesia has
received over 15,000 entries and 13,000 schools
in Uganda entered the competition, with several
other countries still collating the poster entries.
The prize is a visit to the UN palace in Geneva,
Switzerland, supported by the Water Supply
Sanitation Collaborative Council.
Continued
28
29
Lifebuoy way of life
Lifebuoy Way of Life:
Annual Review 2008 - 2009
Tracking social and business Impacts
IN 2008-2009,
THE IMPACT
OF LIFEBUOY
PROGRAMMES
HAS BEEN
TRACKED USING
A VARIETY OF
MEASURES,
INCLUDING
AWARENESS
OF GERMS
AND DISEASES
ASSOCIATED
WITH POOR
HYGIENE, AND
BRAND EQUITY
MEASURES FOR
LIFEBUOY.
IMPACT EXAMPLES FOR 2008-09
• AWARENESS OF GERMS AND LIFEBUOY
BRAND SALIENCE
One of the ways in which the impact of the
Lifebuoy Swasthya Chetna programme has been
evaluated in India is to measure the awareness
of germs, the association of diseases with poor
hygiene and Lifebuoy brand salience. The table
below shows the impact of the programme
following its implementation in 9 states
across India.
Pre-Intervention Post-Intervention
Awareness of germs 52%
83%
Associating germs with disease 35%
57%
Lifebuoy Brand Salience
28%
51%
• LIFEBUOY BRAND EQUITY
The equity of the Lifebuoy brand has been tracked
in countries where social mission activities have
been ongoing, with significant improvement
recorded in brand attributes in these countries.
For example, in Vietnam brand attributes
were found to have been improved, such that
agreement with the statements:
+ Cleanse the skin deeply to
remove invisible dirt
+ Is a brand that you
can trust increased from
65%-> 85%
increased from
65%-> 97%
TRACKING FROM 2010 ONWARDS
In 2010, a complete measurement framework
will be established that will track the impact of
Lifebuoy Social Mission programmes on societies
and business. The overall success of these
programmes – and therefore the success of the
Lifebuoy Social Mission - will be measured by the
impact that Lifebuoy activities have on changing
handwashing behaviours over a 5 year timeframe.
Tracking progress will help to achieve our goals by
identifying whether we are on plan to deliver the
Lifebuoy Social Mission and business target.
THE PILOT
The Lifebuoy brand has been selected by Unilever
to pilot the new Unilever Social Mission Framework
& Metrics, establishing an activated tracking
mechanism in every country. These metrics have
been developed in 2009 by a central team,
including representatives from the Lifebuoy brand
and external consultants. The framework has
also been reviewed by external partners, such as
UNICEF and the World Food Programme, to ensure
compatibility with existing external frameworks.
SIMPLE PRINCIPLE
The metrics are based on a simple principle: what
we put in (the inputs) and what we get out (the
outputs).
For inputs: this means tracking expenditure
made by the Lifebuoy or Unilever brands and any
external collaborators.
For outputs: this means tracking the shortterm and long-term effects of our mission on
our business and on society. These outputs
will include the PR value generated by social
mission activities, brand equity, sales results and
awareness of germs and salience to the
Lifebuoy brand.
Social Mission Metrics essentials: Inputs and Outputs
Goals
30
Inputs
Outputs
Impacts
31
Lifebuoy way of life
Annual Review 2008 - 2009
Rewind and Recap
TOP
The Lifebuoy
10
hygiene and health lessons
learned from 2008-2009:
32
1
2
3
Everyone is doing it!
Use the power of social norms.
Make handwashing with soap seem
ubiquitous; don’t talk about how
rare the practice is, as this will make
people wash less.
The Yuck factor!
Disgust is the evolved motivation
for hygiene, the key motivator, so
use it!
Frame it!
Make sure you frame your message
positively. Don't use fear or disease
threat.
4
5
6
It’s good manners!
Mums teaching kids good
manners is what good
mums do.
Get the habit!
Handwashing is everyday
behaviour and highly habitual.
Target kids: get people early,
before they've formed bad
practices.
Provide rewards.
A strong emotional reinforcer
helps instill habits.
10
Reminders!
7
8
9
Make it easy!
How you can change the situation
so people don't have to work hard
to handwash. For example, keep a
small piece of soap nearby; create
special moment in routine for
handwashing.
The power of the
pledge!
Create a club. Make the
handwashing with soap pledge
public.
Badge it!.
Become a handwashing person/
household. Wear the name
proudly!
Use signs, wall-writing, billboards, anything
in a public space, where it can be seen and
reinforce the behaviour.
33
Lifebuoy way of life
Annual Review 2008 - 2009
Our next steps
The biggest challenge ahead is to lay the right foundations in
2010 for the Lifebuoy brand and its partners to achieve the
By Anuj Rustagi, Lifebuoy Global Brand Director
vision of changing the hygiene behaviour of 1 billion people by
The Lifebuoy Way of Life Challenge –
2015. This will be the biggest contribution of the Lifebuoy brand
Join us and let’s change the hygiene behaviour of
and its partners to the Millennium Development Goal 4, which
1 Billion people by 2015
aims to reduce child mortality by two thirds by 2015. To see
how you can get involved, contact us: lifebuoy@unilever.com
References
1.RE B, SS M, J B. Where and why are 10 million children dying every year? . Lancet
2003;361:2226-34.
2.Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community:
a systematic review. Lancet Infectious Diseases. 2003;3:275-81.
3.Ejemot R, Ehiri J, Meremikwu M, Critchley J. Hand washing for preventing diarrhoea.
Cochrane Database of Systematic Reviews. 2008(1).
4.Fewtrell L, Kay D, Enanoria W, Haller L, Kaufmann R, Colford JM. Water, sanitation and
hygiene interventions to reduce diarrhoea in developing countries; a systematic review and
meta-analysis. Lancet Infectious Diseases. 2005;5(1):42-52.
5.Ensink J. Health impact of handwashing with soap. WELL Factsheets. London; 2004.
6.Luby S, Agboatwalla M, Feikin D, Painter J, Billhimer W, Altaf A, et al. Effect of handwashing
on child health: a randomised controlled trial. The Lancet 2005;366(9481):225-33.
7.Jefferson T, Foxlee R, Mar CD, Dooley L, Ferroni E, Hewak B, et al. Physical interventions to
interrupt or reduce the spread of respiratory viruses: systematic review. BMJ 2008;336:7780.
8.Fung ICH, Cairncross S. Handwashing against SARS: a review. submitted. 2006.
9.Emerson PM, Cairncross S, Bailey RL, Mabey DCW. A review of the evidence for the “F” and
“E” components of the SAFEstrategy for trachoma control. Tropical Medicine & International
Health. 2000;5 (8):515-27.
10.Fung I-H, Cairncross S. Ascariasis and handwashing. Transactions of the Royal Society of
Tropical Medicine and Hygiene. 2009;103 215-22.
11.Bowen A, Ma H, Ou J, Billhimer W, Long T, Ninz E, et al. A cluster-randomized controlled trial
evaluating the effect of a handwashing promotion program in Chinese primary schools. Am
J Trop Med Hyg. 2007; 76. (6):1166-73.
34
12.Rhee V, Mullany L, Khatry S, Katz J, LeClerq S, Darmstadt G, et al. Maternal and birth
attendant hand washing and neonatal mortality in southern Nepal. Arch Pediatr Adolesc
Med 2008 162(7):603-8.
13.Huang D, Zhou J. Effect of intensive handwashing in the prevention of diarrhoeal illness
among patients with AIDS: a randomized controlled study. J Med Microbiol 2007;56(5):65963.
14.Humphrey JH. Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet.
2009;374:1032-35.
15.Jamieson D, Bremen J, Measham A, Alleyne G, Claeson M. Disease Control Priorities in
Developing Countries. Oxford: Oxford University Press; 2006.
16.Curtis V, Danquah L, Aunger R. Planned, motivated and habitual hygiene behaviour: an
eleven country review. Health Education Research. 2009;24(4):655-73.
17.Drummond RP, Stevenson R, Case T, Oaten M. Can the emotion of disgust be harnessed
to promote hand hygiene? Experimental and field-based tests. Social Science & Medicine.
2009;68 1006-12.
18.Scott B, Schmidt W, Aunger R, Garbrah-Aidoo N, Animashaun R. Marketing Hygiene
Behaviours: The Impact of Different Communications Channels on Reported Handwashing
Behaviour of Women in Ghana Health Education Research. 2007;22(4):225-33.
19.G Judah, R Aunger, WP Schmidt, S Michie, S Granger, Curtis. V. Experimental Pretesting
of Hand-Washing Interventions in a Natural Setting. . American Journal of Public Health.
2009;99(S2).
20. Perkins HW. The Social Norms Approach to Prevention. San Francisco.: Jossey Bass,; 2004.
21.Curtis V, Garbrah-Aidoo N, Scott B. Masters of Marketing: Bringing Private Sector Skills to
Public Health Partnerships. American Journal of Public Health. 2007; 97 (4):634-41.
35
Lifebuoy Germ Fighter Drawing Contest entries - Global Handwashing Day 2009
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