The simple act of washing hands with soap at critical times can reduce the number of diarrhoea cases by over 40% 

Together, water, sanitation and good hygiene practices play an important role in preventing disease. However providing clean water and decent toilets does not necessarily mean good hygiene practice follows. That is why we focus on changing hygiene behaviours. 

Poor hygiene has an impact on health and dignity, resulting in lower school attendance and a loss of income. There are many different types of diseases linked to poor hygiene that affect people’s health and contribute to malnutrition. Globally, diarrhoea-type diseases are the second most common cause of death of children under the age of five. 

The importance of handwashing with soap 

Research shows that hand washing at critical times and other good hygiene practices can reduce the risk of diarrhoeal diseases and other sanitation and hygiene-related illnesses when implemented alongside the provision of water and sanitation services. 

Handwashing with soap is one of the most cost-effective and successful ways of combating infectious diseases. But simply providing soap and water is not enough. That is why behaviour change around hand washing with soap at critical times is one of the key focuses of our hygiene promotion programmes. 

Hand washing at critical times: 

  • after defecation
  • after handling children’s faeces
  • before feeding infants and children 
  • before food preparation and before eating 
  • after working in the fields 

Achieving sustainable behaviour change

There are many other behaviours related to hygiene that also reduce illness and disease, from safe food preparation and the protection of water sources, to the safe disposal of human waste and animal dung. 

Sustainable behaviour change is an important part of WASH, but it can be hard to achieve. Lots of factors can influence if and how people change their behaviour including their traditions and habits, their belief in whether they can make the change, and even whether the resources needed are available locally (e.g. soap, tippy taps, water filters). 

Different people may be motivated to change their behaviour and to adopt safe hygiene practices by different things, for example keeping their family healthy or feeling the need to fit in with their community. 

Key approaches to behaviour change in sanitation and hygiene

Key approaches to behaviour change in sanitation and hygiene include: 

PHAST (Participatory Hygiene and Sanitation Transformation)

A facilitated approach that typically involves seven steps to enable communities to analyse their WASH situation and develop their own plans for action. Facilitators and community health workers explore and engage with the different practices within the community and expand upon their understandings in ways that inform, question or challenge.


Through participatory hygiene promotion activities, children can act as agents of change to influence positive hygiene behaviour change in their own families and in their wider communities. An important outcome of the Child-to-Child approach is that children are empowered to take a greater role in decision-making.

Community Health Clubs

A community-based group facilitated by community workers to raise awareness of hygiene issues and support participants to apply their understanding of good hygiene practices in their decision making at home and within the community.

Social marketing

Focuses on increasing the supply of sanitation and hygiene-related products and services based on an understanding of what will motivate people to adopt safe hygiene and sanitation behaviours and so generate demand.

Information, Education, and Communication (IEC)

Learning can be supported in different ways using several strategies. In certain circumstances targeted hygiene information can greatly increase awareness and achieve the desired outcomes such as the promotion of hand washing at critical times to reduce cases of diarrhoeal disease.

Communication strategies are important where issues or practices are disputed or understood differently. Through discussing the different perspectives and knowledge new understandings of an issue can emerge. 

Mediation strategies take a more collaborative and educational approach. The facilitator aims to connect with local issues, experiences and knowledge in ways that help participants to reflect on their own practices and assumptions and to encounter new ideas. 

Guidance notes on hygiene 

Diarrhoea Dialogues: From Policy to Progress (2012) (PDF 4.8 MB)
A collaboration between Tearfund and Path identifies some of the reasons why diarrhoea is still a major cause of child deaths globally and provides helpful guidance on both policy and the implementation of cost-effective and lifesaving strategies. 

Guidance notes on Behavioural Change 

Footsteps is an online and print magazine for grassroots health and development workers. 
Footsteps Edition 97 - Hygiene and Sanitation 

PILLARS Guides provide practical, discussion-based learning on community development.
PILLARS: Encouraging good hygiene and sanitation 

Further reading

The following is a list of resources from other organisations that Tearfund values and integrates into our own WASH guidance (PDF 136 KB)