Colgate-Palmolive: The Central American Hand Washing Initiative

In an innovative and successful child survival partnership program in Central America, USAID-funded BASICS and the Environmental Health Project (EHP) partnered with Colgate-Palmolive/Guatemala and several other soap manufacturers to help reduce child mortality and morbidity from diarrheal disease. From 1996 to 1999, a comprehensive consumer education communications and advertising campaign was conducted in three Central American countries: Costa Rica, El Salvador, and Guatemala.

The Problem: Diarrheal Disease

In developing countries an estimated 2.2 million children under the age of five die every year from diarrheal disease. Diarrheal disease has long been a challenge in Central America where it is responsible for more than 20 percent of the under-five mortality in El Salvador and as much as 45 percent in Guatemala.

Hand washing impedes the ingestion of fecal matter transmitted from an individual's hands to water or food, and may reduce the incidence of diarrhea by 35 percent or more. Behavioral research showed that only nine percent of targeted mothers had hand washing practices that were considered optimal, while 65 percent of mothers' practices were considered inadequate. Ninety-one percent of the mothers surveyed required improvement in their hand washing behavior.

The Solution

Hand washing has been documented as one of the most effective means of preventing the transfer of bacteria and germs to food and water. Public health practitioners observed that hand washing is generally not done in many areas of Central America, or it is done ineffectively without soap or at the wrong times. Hand washing behavior was seen as a straightforward and cost-effective way to prevent or reduce diarrheal diseases. To improve hand washing behavior, the BASICS/EHP team recognized that several interventions needed to occur. First, soap needed to be made more readily available to at-risk children's parents, and information on proper hand washing practiceswhy and how and whenneeded to be introduced to these parents. The private sector was seen as a potential stakeholder in this hand washing initiative and a valuable ally.

BASICS and EHP formed the Central American Hand Washing Initiative to help in addressing this problem. It negotiated with four major soap-producing companies in Central AmericaColgate-Palmolive in Guatemala and Unisola [Unilever] in El Salvadorand two regional soap producers, La Popular of Guatemala and Punto Rojo of Costa Rica, to participate in the initiative. The companies' contributions to the partnership included soaps, promotion of their soaps as health products, repositioning soap with a hand washing logo, and distribution of consumer education messages and instructions. The four manufacturers themselves decided which of their individual soap products they would introduce in the health education and communications campaign. In order to save time and money, the companies chose laundry soaps that were already found in the majority of the targeted households and were readily available at local markets and stores. The manufacturers then positioned each line of soap as effective products for promoting hygiene and preventing diarrheal diseases, and identified them by logo and consumer education.

The education campaign stressed that hands should be washed before eating or feeding a child, after defecation, and after changing a baby. It also instructed mothers to use both water and soap, to rub the hands at least three times, and to dry them off with a clean towel. The official theme for the campaign was "Manos limpias, evitan la diarrhea" (clean hands prevent diarrhea). The campaign slogan was "Lavo mis manos por salud" (I wash my hands for health).

Advertising and marketing campaigns were country-specific and developed by each soap's manufacturer. In addition to its commercial advertisements, Colgate-Palmolive organized a series of public relations events to support the program. In El Salvador, Unisola [Unilever] worked closely with the Ministry of Health to strengthen its Healthy Schools program. La Popular integrated the campaign into its sales operations by arranging for its sales force to distribute educational materials to small towns and villages in Guatemala. In Costa Rica, Punto Rojo was successful in leveraging significant support from the media, earning pro-bono advertising from radio, television, and the print media.

Results

• Diarrheal disease decreasedThere was a sustained improvement in hand washing behavior following the Initiative with an estimated overall reduction of five percent in the incidence of diarrhea for children under the age of five.
• Hand-washing behavior improvedIn Guatemala (the primary evaluation area), 10 percent of the mothers included in the assessment had improved their hand-washing frequency and technique from an inadequate or intermediate level to the optimal level.
• Partnership activities leveraged significant resources for public health and child survivalBASICS and Environmental Health Project (EHP) leveraged additional resources and promotional support from Colgate-Palmolive and the other partner companies and organizations at a value of $614,900.
• Increased sales for soap companiesThough the specific sales numbers were not provided by the participating companies, several of the soap manufacturers indicated that sales of the related soap products had increased in the areas where the Hand Washing Initiative had taken place.
• Sustainable changes and improved understanding among partnersThe experience of developing and implementing the Central American Hand Washing Initiative afforded each of the participating partners a greater level of understanding about the benefits and challenges of public-private initiatives and the need for such programs in global child survival efforts. The companies involved in the Initiative benefited by learning new approaches and techniques for soap promotion and gained experience working in collaboration with government, donor organization and the media. The public sector's involvement in the Initiative resulted in important improvements in regional hygiene programs and the competence of personnel in hand-washing promotion through increased participation of the private sector and the development of new multi-sector networks and associations.
• Colgate-Palmolive is launching a special school program region-wide and will be using a number of the creative concepts that had been developed during the Initiative to advertise its brand of anti-bacterial soap, called "Protex."
• Unisola has continued its partnership efforts in child survival and public health by working closely with BASICS to address the problem of cholera in El Salvador.
• In April of 2000, the Ministry of Health in Guatemala, in collaboration with the soap producers, announced its plans for continuing the hand-washing campaign through 2003 through it's National Plan for Healthy Schools and Municipal Health Promoters.

The private sector's participation in this partnership served as a significant public service in reinforcing and supplementing the child survival efforts of both the public and non-profit sectors, while developing and expanding its own market for inexpensive hand washing soap. With significant results and a legacy of additional programs and public health improvements, the Central American Hand Washing Initiative represents an important example of public-private collaboration in child survival.

For more information, contact:
Camille Saade
Technical Officer and Social Marketing Specialist
Academy for Educational Development
Tel:
E-mail: