Poor hand hygiene contributes to transmission of diseases

The annual average number of reported cases of water-borne diseases, which may be spread primarily
through improper hand hygiene, has reached more than 50,000 from 2010 to 2019. Typhoid fever and
acute bloody diarrhea have been shown to be more fatal, but these deaths are preventable through
frequent and proper handwashing.

SOURCE: PSA CPES (2016, 2022)

Promoting and sustaining
proper hand hygiene is not
as easy as it sounds.
Promoting and sustaining
proper hand hygiene is not
as easy as it sounds.
93% 89% 3%
 3%

Even with education, policy,

and infrastructure in place,
hand hygiene can still be
forgotten
 Health Promotion Playbook
All-in-one guide for LGUs to implement health promotion interventions
Building Health Creating Strengthening Developing Reorient Health
Public Policy Supportive Community Personal Skills Services
Environments Action
Building Health Creating Supportive Strengthening Developing Personal Reorient Health Services
Environments Community Action Skills
Public Policy
Building Health Public Creating Strengthening Developing Personal Reorient Health Services
Policy Community Action Skills
Supportive
Environments
Building Health Public Creating Supportive Developing Personal Reorient Health Services
Policy
Strengthening Skills
Environments
Community
Action
Building Health Public Creating Supportive Strengthening Developing Reorient Health Services
Policy Environments Community Action
Personal Skills
Building Health Public Creating Supportive Strengthening Developing Personal Reorient Health
Policy Environments Community Action Skills
Services
Building Health Public Creating Supportive Strengthening Developing Personal Reorient Health
Policy Environments Community Action Skills
Services
 WHAT’S IN THE PLAYBOOK?

Summary of Evidence Policy Implementation Plan Resource

Requirements

Capacity-Development Communication Plan Monitoring & Frequently Asked

Evaluation Questions
 WHAT’S IN THE PLAYBOOK?

Summary of Policy Implementation Plan Resource

Evidence Requirements

Capacity-Development Communication Plan Monitoring & Frequently Asked

Evaluation Questions
 WHAT’S IN THE PLAYBOOK?

Summary of Evidence Policy Implementation Plan Resource

Requirements

Capacity-Development Communication Plan Monitoring & Frequently Asked

Evaluation Questions
 WHAT’S IN THE PLAYBOOK?

Summary of Evidence Policy Implementation Plan Resource

Requirements

Capacity-Development Communication Plan Monitoring & Frequently Asked

Evaluation Questions
 WHAT’S IN THE PLAYBOOK?

Summary of Evidence Policy Implementation Plan Resource

Requirements

Capacity-Development Communication Plan Monitoring & Frequently Asked

Evaluation Questions
 WHAT’S IN THE PLAYBOOK?

Summary of Evidence Policy Implementation Plan Resource

Requirements

Capacity- Communication Plan Monitoring & Frequently Asked

Development Evaluation Questions
 WHAT’S IN THE PLAYBOOK?

Summary of Evidence Policy Implementation Plan Resource

Requirements

Capacity-Development Communication Monitoring & Frequently Asked

Plan Evaluation Questions
 WHAT’S IN THE PLAYBOOK?

Summary of Evidence Policy Implementation Plan Resource

Requirements

Capacity-Development Communication Plan Monitoring & Frequently Asked

Evaluation Questions
 WHAT’S IN THE PLAYBOOK?

Summary of Evidence Policy Implementation Plan Resource

Requirements

Capacity-Development Communication Plan Monitoring & Frequently Asked

Evaluation Questions
 Engage with

1 4 7
Prepare logistical and Develop and implement
stakeholders, target
resource needs for communication or other
audiences, and local
implementation auxiliary activities
implementers

Create a Behavioral
Conduct capacity Conduct regular

2 5 8
Nudge Master Plan
building activities for inspection, maintenance,
customized to the needs
identified local and monitoring and
and contexts of the
implementers evaluation
localities
 Engage with

1 4 7
Prepare logistical and Develop and implement
stakeholders, target
resource needs for communication or other
audiences, and local
implementation auxiliary activities
implementers

Create a Behavioral
Conduct capacity Conduct regular

2 5 8
Nudge Master Plan
building activities for inspection, maintenance,
customized to the needs
identified local and monitoring and
and contexts of the
implementers evaluation
localities
Why Behavioral Nudges for Hand Hygiene?

Behavioral nudges are effective,

Handwashing can prevent the
low-cost, and easily scalable
transmission of diseases
interventions
 Engage with

1 4 7
Prepare logistical and Develop and implement
stakeholders, target
resource needs for communication or other
audiences, and local
implementation auxiliary activities
implementers

❑ Select priority settings and map out strategic areas where behavioral
nudges can be installed
Create a Behavioral
Conduct capacity Conduct regular

2 5 building❑
8
Nudge Master Plan Identify
activities for communication andinspection,
community engagement activities which
maintenance,
customized to the
identified localcan be conducted in support of the
and intervention
monitoring and
needs and contexts of
implementers evaluation
the localities
❑ Develop a monitoring system for routine inspection, maintenance, and
evaluation
❑ For the development of these plans, you may refer to the tools available
in the Playbook:
a. Implementers’ Guide to Behavioral Nudges
b. Resource Requirements
c. Template Nudge Designs & Communication Materials
d. Templates for M&E Reporting, Observation & Spot-Check,
Intercept Survey
❑ Explore partnerships for the different activities involved in
implementing nudge-based interventions
Implementers’ Guide to Behavioral Nudges

Contents:
● Decision Tool
● Types of Behavioral Nudges
○ Contextual Cues
○ Visual Reminders
● Recommended Application
and Recommended Settings
 Engage with

1 4 7
Prepare logistical and Develop and implement
stakeholders, target
resource needs for communication or other
audiences, and local
implementation auxiliary activities
implementers

Create a Behavioral
Conduct capacity Conduct regular

2 5 8
Nudge Master Plan
building activities for inspection, maintenance,
customized to the needs
identified local and monitoring and
and contexts of the
implementers evaluation
localities
Scope and Coverage:
Establishment of accessible and well-maintained handwashing facilities and/or sanitation stations with proper supplies and
installed with behavioral nudges encouraging proper hand hygiene, in priority settings such as:

Schools Offices, Markets, Food & Service Shelters, Evacuation

Workplaces Groceries Establishments Centers

Hospitals, Health Places of Worship Transport Recreational

Centers Terminals Areas, Parks
Downloadable via https://tinyurl.com/PA2Playbook-TemplatePolicy

Principal Implementers:
The Local Health Office shall have the following responsibilities:

1. Lead the development of the Behavioral Nudge Master Plan with relevant stakeholders
2. Identify priority settings for installation of hand hygiene facilities and behavioral nudges
3. Prepare costing and budget for behavioral nudges and other activities
4. Facilitate capacity building activities for local implementers
5. Develop and oversee communication efforts and auxiliary programs
6. Oversee the monitoring system for routine inspection, maintenance, and evaluation
7. Discuss findings with stakeholders and make necessary adjustments to the Plan and
intervention
Downloadable via https://tinyurl.com/PA2Playbook-TemplatePolicy

Considerations for Planning & Design:

Hand hygiene facilities / stations: Behavioral nudges:

Locations where handwashing should occur Surprising to target audiences

Ample space that is safe and secure Clearly understandable and eye-catching

Foot traffic Affordable and can be produced locally

Access to water supply, tappable water line Inclusive

Appeal, affordability, ease of maintenance

Availability of soap, alcohol, paper towels

Accessibility to all people

Downloadable via https://tinyurl.com/PA2Playbook-TemplatePolicy

Reporting and Monitoring:

The Local Health Office shall lead and oversee the regular
monitoring and evaluation of the intervention.
● Other relevant office/s or individuals may be designated,
but all data gathered shall be consolidated by the Health
Office for regular reporting to the Local Health Board.

● Data shall be used to decide on necessary actions, such

as adjusting or modifying existing set of nudges, redesigning,
or installing a new set of nudges, and the frequency
of such actions.
Downloadable via https://tinyurl.com/PA2Playbook-TemplatePolicy

Other Recommended Activities:

Free hygiene kits Incentive Research

mechanisms

Policies Communication
Training activities
 Engage with

1 4 7
Prepare logistical and Develop and implement
stakeholders, target
resource needs for communication or other
audiences, and local
implementation auxiliary activities
implementers

Create a Behavioral
Conduct capacity Conduct regular

2 5 8
Nudge Master Plan
building activities for inspection, maintenance,
customized to the needs
identified local and monitoring and
and contexts of the
implementers evaluation
localities
 Resource Type Description Object Class Quantity
Waterproof sticker paper

Board paper
# of behavioral nudges to
Photo paper Office Supplies Expenses be installed per identified
setting/site
Laminating film

Printer ink cartridges

Oil-based paint (for rough surfaces, floors)

Behavioral Nudge
Paintbrush, paint roller (for rough surfaces, floors)
Materials
Cement (for rough surfaces, floors)

Liquid / bar soap Other Supplies and Materials Expenses # of handwashing

facilities and/or sanitation
Soap dish / dispenser Other Maintenance and Operating Expenses stations

Tissue / paper towel

Tissue holder / paper towel dispenser

Bathroom mirror
Resource Type Description Object Class Quantity
Semi-expendable - Other Machinery and
Hand dryer # of handwashing
Equipment / Electricity Expenses
facilities and/or
Behavioral Nudge Labor (If painting, cementing works needed or for pre- Other Professional Services sanitation stations
Materials fabrication of WASH O’Clock handwashing kiosk)

Printer Semi-Expendable - Printing Equipment As needed

WASH O’Clock Handwashing Kiosk

● ¾ Marine plywood (semi-gloss white finish)
● Plain sheet gauge 20
● Gooseneck faucet (stainless/chrome) Other Supplies and Materials Expenses
● Foot pedal mechanism set (stainless/chrome) # of identified settings /
Handwashing ● Flexible hose Water Expenses
sites where facilities
Facilities ● Stainless steel sink (15x18 in) Other Professional Services
● Vinyl tiles (12x12 in) need to be installed
● Wall-mounted soap dispenser Other Maintenance and Operating Expenses
● ½ Flexible drain hose
● ½ PVC pipe
● Versa board (32x78 in)

Vinyl / tarpaulin (24x46 in)

Communication # of identified settings /
Vellum board (18x27 in | 210-300 gsm | glossy) Printing and Publication Expenses
Materials sites
Cardboard / acrylic sheet (5.85x8.25 in)
 Resource Type Description Object Class Quantity

Capacity Building for # of sessions / batches of

Training logistics (venue, meals, and other training collaterals) Training Expenses
Implementers implementers to be trained

Consultation and Planning with Representation Frequency or # of meetings

Logistics for regular meetings (venue, meals, transportation)
Stakeholders Expenses to be held

MOA or MOU processing costs (Only applicable If the LGU is Accountable Forms
Admin & Legal Requirements receiving grants from national or regional government, or from other As needed
Expenses
entities)
 Engage with

1 4 7
Prepare logistical and Develop and implement
stakeholders, target
resource needs for communication or other
audiences, and local
implementation auxiliary activities
implementers

Create a Behavioral
Conduct capacity Conduct regular

2 5 8
Nudge Master Plan
building activities for inspection, maintenance,
customized to the needs
identified local and monitoring and
and contexts of the
implementers evaluation
localities
Training for local implementers (City/Municipal Health Officers, HEPOs, Sanitary Engineers & Inspectors, Public Health Nurses,
etc.) available at DOH Academy

Learning Outcomes
By the end of the course, participants involved in the planning and
implementation of the intervention should be able to:
1. Understand the importance of proper sanitation and hand hygiene
2. Apply social and behavior change communication (SBCC) and
behavior-centered design in planning for behavioral nudges
3. Develop communication and relationship-building skills for
community engagement and demand generation for healthy choices and
behaviors
4. Produce an action plan (LGU Behavioral Nudge Master Plan) to guide
implementation and monitoring of the intervention and other
complementary strategies
Training for local implementers (City/Municipal Health Officers, HEPOs, Sanitary Engineers & Inspectors, Public Health Nurses,
etc.) available at DOH Academy

Modules
1. Water, Sanitation, and Hygiene in the Community
• Empowering Communities through Water, Sanitation, and Hygiene
• Strategies for Stronger Engagement in WASH Education Activities

2. Social and Behavior Change Communication for Hand Hygiene

• Introduction to Social and Behavior Change Communication
• The P-Process Framework
• Strategic Communication Process
• Behavior Centered Design and Behavioral Nudges
• Communication Research

3. Strengthening Communication and Presentation Skills for Hand

Hygiene Champions
• Communication Tools and Rapport Building
Duration: 9 hours • Non-verbal Indicators and Presentations
 Develop and
Engage with

1 4 7
Prepare logistical and implement
stakeholders, target
resource needs for communication or
audiences, and local
implementation other auxiliary
implementers
activities

Create a Behavioral
Conduct capacity Conduct regular

2 5 8
Nudge Master Plan
building activities for inspection, maintenance,
customized to the needs
identified local and monitoring and
and contexts of the
implementers evaluation
localities
Behavioral nudges alone may not be enough to sustain proper hand hygiene behaviors, but are more effective with other
strategies, such as communication campaigns and advocacy efforts.

BIDA Solusyon Plus sa COVID-19 WASH O’Clock Campaign

B Bawal walang mask at face shield Signages and handwashing kiosks are used as nudges to
I I-sanitize ang kamay at iwasan ang kulob na lugar encourage proper handwashing during critical moments in
D Dumistansya ng isang metro at limitahan ang pisikal na various community settings
interaksyon sa iba
● Post out-of-home reminders in key locations and
A Alamin ang tamang impormasyon
means of transportation
Plus Suportahan ang FDA approved na bakuna
● Hold inaugurations for handwashing facilities with
nudges to showcase LGU’s initiative
● Install campaign materials and designs as behavioral
nudges ● Air videos, jingles, public services
announcements on TV or radio stations
● Use different types of nudges to reinforce the “I-sanitize
ang kamay' component and messaging ● Conduct community activities such as roving
caravans, bandilyos, motorcades
Communication Materials
Downloadable via http://tinyurl.com/BehavioralNudgeDesigns

Template behavioral nudge designs are available in the Playbook!

Communication Materials
Downloadable via http://tinyurl.com/BehavioralNudgeDesigns

Template behavioral nudge designs are available in the Playbook!

Communication Materials
Downloadable via: http://bit.ly/BIDAallFiles or BIDA Decals/Stickers
Communication Materials
Downloadable via: https://bit.ly/WashOClockCampaignMaterials

WASH O’Clock signages & handwashing kiosk designs are available in the Playbook!
 Engage with

1 4 7
Prepare logistical and Develop and implement
stakeholders, target
resource needs for communication or other
audiences, and local
implementation auxiliary activities
implementers

Create a Behavioral Conduct regular

Conduct capacity

2 5 8
Nudge Master Plan inspection,
building activities for
customized to the needs maintenance, and
identified local
and contexts of the monitoring and
implementers
localities evaluation
 Summary of Indicators Change M&E Form
Outputs
● Number of existing and new handwashing facilities and sanitation Increase Monitoring and Evaluation Reporting
stations in identified priority settings/areas Template
● Number of bar soaps or volume of liquid soap used in identified Increase Facility Observation and Spot Check
handwashing facilities Template
● Water meter reading (if dedicated meter installed) Increase

Expected Behaviors
● Usage rate of handwashing facilities and sanitation stations with Increase (higher actual Proper Handwashing Observation
behavioral nudges installed (actual vs. potential users) vs. potential) Form
● Number of users observed practicing proper handwashing steps Increase Intercept Survey Form
● Incidence of infectious diseases related to hand hygiene - e.g.,
COVID-19, diarrhea, other gastrointestinal and respiratory Decrease Health Literacy Assessment and
illnesses Knowledge, Attitudes and Practice on
Health Promotion (HLA-KAP) Survey
Downloadable via: https://tinyurl.com/PA2Playbook-TemplateMonitoring

Reporting & Monitoring Form Facility Observation & Spot Check Template

Template monitoring & evaluation forms available in the Playbook!

 Intercept Survey Form
Downloadable via: https://tinyurl.com/PA2Playbook-TemplateMonitoring

Proper Handwashing Observation Form

Template monitoring & evaluation forms available in the Playbook!

Thanks for
having us!
Questions? Let’s talk!
[email protected]

Reach the Department of Health

on social media:

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@DOH.Philippines

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