COVID-19: WSSCC Programming and Guidance Brief

30 April 2020

The COVID-19 pandemic has affected all countries where WSSCC has ongoing Global Sanitation Fund-supported programmes and National Coordinators. Programming has been directed to national prevention efforts. WSSCC has compiled what we view as the most useful information and practical guidance at this point, alongside a wider set of resources and some of the good practices gathered from our country partners. Entitled COVID-19 information and guidance for programmes, it is intended to provide the latest information on COVID-19 and offer practical guidance.

Note that evidence and guidance for best practices are continually emerging, and that countries differ in the extent and nature of their COVID-19 responses. The guidance contained in this briefing note is not exhaustive but will be updated to reflect the latest information available. Always consult with your national health authorities for the latest guidance in your area.

(French available early May).

Content Summary

  • What is COVID-19 and how it is spread
  • Guidance for handwashing including when hands should be washed, effective materials, water quality and facility feature
  • Guidance for cleaning sanitation facilities
  • Guidance on other preventative measures including avoiding face touching, social distancing, cleaning and wearing face masks
  • Guidance for prevention outreach including good programming practices, campaign design, behaviour change approaches for communities, health care facilities and schools and considerations for Menstrual Health and Hygiene (MHH) programming and people who may be disadvantaged
  • Further resources

Extracts from the Brief

COVID-19 and water, sanitation, and hygiene

The COVID-19 virus has not been detected in drinking-water supplies, and based on current evidence, the risk to water supplies is low – although it is acknowledged that persistence in drinking water may be possible.

Evidence indicates that the risk of catching COVID-19 from the faeces of an infected person appears to be low. While initial investigations suggest the virus may be present in faeces in some cases, spread through the faecal-oral route does not seem a main feature of the outbreak. However, because this is still a transmission risk, ensuring that excreta is safely contained, emptied, transported, and disposed or treated in line with the WHO’s Guidelines on Sanitation and Health is an important precaution.

Handwashing with soap is one of the most critical actions for preventing the spread of COVID-19.

Examples of low-cost handwashing facilities

What is effective to wash your hands with?

Regular soap recommended for handwashing. Soap destroys the COVID-19 virus at the molecular level. Soap does not need to be liquid or anti-bacterial; any regular bar of soap is effective. Contrary to popular belief, regular soap is just as effective as alcohol-based hand sanitizer
Alcohol-based hand sanitizer should contain at least 60% alcohol. The advantage of hand sanitizer is that it can be used without water, making it useful when traveling. However, because it is generally less prevalent and more expensive than regular soap, it should not be promoted instead of regular soap.
Soapy water made from soap powder or detergent can be used as an alternative if bars of soap are scarce.
Ash should be the last-resort alternative for handwashing. Ash can help kill viruses because it forms an alkaline solution when mixed with water. Ash can also be mixed with sodium bicarbonate (baking soda), which raises the level of alkalinity, to make a bar of homemade soap alternative.

Guidance for cleaning sanitation facilities

Extra precautions should be taken when cleaning sanitation facilities when there are suspected or confirmed cases of COVID-19. Toilets should be cleaned and disinfected daily (twice in healthcare settings), using soap or household detergent to clean first. A mask, goggles, a fluid-resistant apron and gloves should be worn while cleaning. When finished, cleaning and removing personal protection equipment (PPE), wash hands with soap and water. Nose, mouth, eye and anal cleaning residue should be disposed in a closed bin or bag. Dry-pit latrines are likely to pose less risks, although it is still recommended to clean latrines used by somebody with COVID-19 once a day, thoroughly washing hands afterwards with soap and water.

 

Guidance on other preventative measures

In addition to maintaining social distance, avoiding touching one’s face and cleaning surfaces, the Brief provides guidance on the use of face masks. Although there is conflicting guidance on the use of masks to protect against the contraction, the evidence on the effectiveness of masks in non-medical settings is inconclusive, and official rules and public consensus surrounding mask use vary widely between countries. WSSCC follows current WHO guidance that people should only wear masks if they are ill with COVID-19 symptoms (especially coughing) or looking after someone who may have COVID-19 and that medical-grade masks be reserved for healthcare workers.

 

General good programming practices

  • Focus on sustainable WASH: safely managed sanitation services and good hygiene practices are not just for preventing the spread of COVID-19, but for preventing the prevalence of dozens of other common (yet deadly) diseases and ensuring dignity for all.
  • Designate a COVID-19 focal point: appoint one member of staff to serve as the main focal point for compiling and disseminating updates on COVID-19 and for rapidly answering questions or coordinating support, for implementing partners.
  • Maintain periodic communication with partners: it is recommended that programmes hold weekly calls with implementing partners to keep them updated on the current situation, address their questions and concerns, and to help share innovations and good practices.
  • Remote monitoring: where staff are not able to visit the field, programmes could consider introducing mobile-based data collection tools such as Kobo Toolbox.
  • Don’t leave documentation behind: because this is a new and challenging way of programming for everyone, it is important that good practices, challenges, and lessons learned are documented and fed-back into programming.

Designing a handwashing campaign

Programmes should find creative behaviour change approaches to instil good sanitation and hygiene habits both during and after the pandemic.

  1. Identify desired handwashing outcomes: Clearly identify the specific handwashing outcomes your campaign is aiming to achieve – both for preventing COVID-19 and the other critical handwashing moments.
  2. Evaluate existing evidence and approaches
  3. Mapping current campaigns
  4. Assess existing attitudes: If possible, programmes should conduct rapid assessments to learn about the prevailing attitudes/perceptions about handwashing with soap and COVID-19 (including any misconceptions and myths).
  5. Identify communication channels: to keep handwashing messaging surprising and to accommodate for the different ways information is consumed, handwashing messaging should utilize a wide variety of formats as possible. This includes posters (especially those which serve as behavioural prompts), radio, television, Facebook and WhatsApp groups, and the word of mouth of community leaders.
  6. Develop a monitoring plan: clearly articulate how your programme will measure whether your campaign is working or not.

General do’s and don’ts for developing behaviour change approaches

The following list of do’s and don’ts can be applied for households, communities, healthcare facilities, and schools.

Do’s

Behaviour change campaigns should address handwashing at all critical times, including after using the toilet and before eating (see above).

  • Messaging should target core emotional drivers. People often change their behaviour not to improve their health, but for other emotional reasons.
  • Be conscious of the behaviour environment. Its also useful to consider how ‘nudging’ can be used as physical cues that influence individuals to behave in a certain way, without messaging.
  • Link handwashing with common events to form unconscious associations. For example, posters that link handwashing with routine activities such as getting home, blowing nose, eating/handling food, or placing coloured stickers on objects/areas associated with handwashing.
  • Link messages to small immediate do-able actions.
  • Keep messaging simple.
  • Make handwashing messages surprising by frequently changing them.
  • Use trusted local leaders and influencers to spread handwashing messaging, such as religious leaders, traditional authorities, media figures, and political leaders.
  • Celebrate handwashing champions, for example, through recognition walls, social media recognition, and public acknowledgements by local leaders
  • Correct misconceptions.
  • Share real experiences of COVID-19.

Don’ts

Behaviour change messaging should not give the impression that handwashing with soap is only important for COVID-19.

 

  • Don’t rely on ‘health education’ alone. Repeated studies show that sensitizing or awareness raising about disease transmission alone is not effective for changing behaviour.
  • Don’t install handwashing facilities without considering the surrounding environment. Always combine facility installation with messaging and adaptations to the surroundings.
  • Don’t use fear-based messaging.
  • Don’t make the messaging complex.
  • Don’t keep your messaging boring and unchanging.
  • Don’t rely only on programme staff to develop and deliver messaging. Communities should be directly involved in all prevention outreach activities.
  • Lecture or scold individuals and communities about their handwashing practices.
  • Don’t leave potentially harmful myths to go unaddressed.
  • Avoid amplifying messages that places blame on individuals and stokes fear and suspicion.

Considerations for Menstrual Health and Hygiene (MHH) programming

COVID-19 has in many countries led to restricted mobility, which in turn can lead  to increased challenges in obtaining certain essential items, reduced interaction with social support networks, reduced privacy of household members who are usually out of the house but now under lockdown, and heightened stress – any or all of these dimensions may have impacts on MHM. Overall, we must ensure that policies and procedures recognize MHH needs as basic and essential hygiene needs.

When WASH or other hygiene information is disseminated, it should include MHH components.

  • When sanitation and hygiene information are broadcast to the community, ensure men/boys and women/girls receive at least basic MHH information.
  • Instructions for how to make, clean, and eventually dispose of homemade, reusable menstrual products should be distributed.
  • Menstrual hygiene products should be listed by government entities as essential commodities. (Or if production restrictions are in place, they should be listed as exceptions.)
  • When menstruators are quarantined in official care centres (such as in India), they should be provided menstrual hygiene products, soap, and other basic essential hygiene items. Any distribution of food, soap or other sanitation equipment, and any other basic, essential items (to healthcare facilities or households) should include menstrual hygiene products.
  • Companies should be discouraged or prevented from increasing the price of menstrual hygiene products, even though supply is decreased, and demand has remained stable or even increased.
  • Remove barriers to manufacturing and supply of menstrual products.

Considerations for people who may be disadvantaged

  • Map out individuals and households who are most vulnerable: identifying households with at-risk individuals (eg. elderly, those with underlying health conditions, or with a disability) can help local authorities prioritize where preventative and curative efforts need to be prioritized.
  • Partner with organizations working with disadvantaged groups. Remember the motto “nothing about us, without us” when addressing the needs of those who might be left behind.
  • Messaging should be available in a variety of formats to accommodate the needs of different people, such as audio and braille formats for people who are blind and sign language for people who are deaf. Children and people with intellectual disabilities are also more likely to respond to messages with simple and engaging pictures.
  • Translate messaging into local languages.
  • Consider information channels that will be accessed by persons with limited mobility. Special measures should be taken to ensure the elderly, people with disabilities, those who are ill and other people less able to leave the home are able to receive messaging.
  • Portray different types of people in messages. COVID-19 can be transmitted by anyone and has the potential to make anyone seriously ill.
  • Be careful how COVID-19 and its spread is discussed.
  • “Do no harm”—ensure that interventions have no unintended negative consequences. For example, large public gatherings can create risks of virus transmission
  • Develop specific messages to explain the risk for elderly and how to care for them. 
  • Prioritize household visits or outreach to people who are most disadvantaged. Using existing community networks and observing social distancing measures, visits/calls should be made wherever possible to households who do not have existing support networks or are particularly high-risk.
  • Be transparent when distributing products: when distributing handwashing facilities, soap, or other hygiene products, ensure that decisions on who is allocated support are clearly communicated with the community in coordination with local authorities and trusted local institutions.
  • Monitor secondary impacts of COVID-19 that hinder people from adopting hygiene behaviours (e.g. increased prices of WASH products and services). See a guide here.

FURTHER RESOURCES

A substantial list of online resources  is found here.