- Change hygiene behaviours.
- Distribute and monitor hygiene items.
- Contribute to the cholera response.
1Promoting hygiene
Building infrastructure is not enough: people must use it and adopt safe practices. Hygiene promotion is based on understanding behaviours: what people know, but also what motivates them (disgust, pride, caring for children, social norms) and what prevents them from acting (no soap, no water, no time).
- Key practices: handwashing with soap at critical times (after using the toilet, after cleaning a child, before preparing food, eating or feeding a child), latrine use, treated and safely stored water, food hygiene.
- Participatory methods: household visits by community hygiene promoters, demonstrations, focus group discussions, schools, radio.
- Monitoring through observation and simple surveys, not just the number of sessions.
2Hygiene items
- Hygiene kits adapted to and discussed with the community: soap (benchmark of around 250 g of soap per person per month for personal hygiene, more for laundry), water containers, menstrual hygiene products, items for babies and for people with incontinence.
- Distribution in kind or through cash transfers and vouchers if markets are functioning.
- Post-distribution monitoring: are the items being used? Is anything missing?
3The cholera response
Cholera causes acute watery diarrhoea and dehydration that can kill within hours without treatment; with prompt case management (oral rehydration salts, intravenous fluids for severe cases), the case fatality rate should remain below 1%.
- Health-WASH coordination: cholera treatment centres and units (CTCs, CTUs), oral rehydration points in communities.
- Reinforced chlorinated water supply (higher residual chlorine), household water treatment.
- Case-area targeted interventions (CATI): teams that visit households around a confirmed case to distribute water treatment products and soap, and to disinfect.
- Hygiene in treatment centres, disinfection, safe and dignified burials.
- Risk communication and community engagement; oral cholera vaccination in line with the decisions of the health authorities.
Cholera alert
Peri-urban neighbourhood
You are your NGO's WASH focal point. The Ministry of Health confirms three cases of cholera in the neighbourhood.
A cholera treatment unit is opening at the health centre. The families of the cases live near an unprotected well used by 300 households.
Decision 1 of 3What action do you launch around the cases?
Decision 2 of 3What do you do about the unprotected well?
Decision 3 of 3Which key message should you prioritise with community leaders?
Key takeaways
In the face of cholera: case-area targeted interventions, safe water, hygiene and rapid referral to rehydration.
Exercise: a hygiene promotion plan
Cholera cases are reported in a neighbourhood. Prepare a one-week plan: key messages (three at most), channels (radio, visits, religious leaders, schools), deployment of promoters, distribution of items, and two indicators to know whether practices are changing.
Key points
- Understand what motivates and what blocks behaviours, rather than just passing on messages.
- Handwashing with soap at critical times.
- Cholera: rapid rehydration; keep the case fatality rate below 1%.
- Case-area targeted interventions and close coordination with health.
Further reading: course references
- Sphere Association (2018). The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. spherestandards.org/fr/manuel-2018
- WHO (2022). Guidelines for Drinking-water Quality (4th edition). www.who.int/publications/i/item/9789240045064
- Eawag / GWC (2018). Compendium of Sanitation Technologies in Emergencies. www.eawag.ch
- Global WASH Cluster (UNICEF) (2024). Global WASH Cluster resources. washcluster.net
Daily quiz
3 questions to check what you have learned. Answer them all to complete the day.