Hygiene Improvement Framework (HIF)

The Hygiene Improvement Framework (HIF) is a tool for designing and implementing diarrhoea prevention activities. It is not an approach as such but a comprehensive framework which attempts to prevent diarrhoea by addressing three key components: access to the necessary hardware or technologies, promoting healthy behaviours and support for an enabling environment to ensure wide-scale application and sustainability.

Table of Contents

Background

The HIF was originally developed by the Environmental Health Project (EHP) of the United States Agency for International Development (USAID) and was first used in Central America in 1999; it has since been further refined by UNICEF, Water and Sanitation Program of the World Bank (WSP) and others.

The HIF is a holistic programming framework where all aspects of hygiene are promoted including improvements to water supply services.  It is based on the premise that in order to prevent diarrhoea an intervention should comprise three components: access to hardware, hygiene promotion and an enabling environment.  These three components are the key elements of the framework and are designed to encourage household behaviours that reduce the incidence of childhood diarrhoea, namely: safe disposal of faeces, washing hands correctly at the right times, and storing and using safe water for drinking and cooking.

Improving access to hardware includes:

  • Continuous safe water supply systems to communities and neighbourhoods.
  • Sanitation facilities to dispose of faeces, especially the faeces of young children.
  • Technologies and materials for improving household level hygiene, such as soap, water treatment and safe storage containers.

HIF can equally be applied to both urban and rural programming. 

Experience to date

The HIF has been used in Bangladesh, Guatemala, Jamaica, Nicaragua, DR Congo, Ethiopia, Kenya, Madagascar, Mozambique and Uganda.  USAID has developed a number of programmes using the framework including the Community-led Total Behaviour Change programme being implemented by the Government of Ethiopia, supported both by USAID and WSP; see Amhara National Regional State Health Bureau (2005). 

UNICEF has also adapted the HIF as the framework of its current WASH strategy.

Evidence of effectiveness

Since it is not an approach in itself (but a framework within which other approaches can be implemented) its effectiveness has not been assessed independently.

USAID/HIP (2009).  WASH Training Package for the Prevention of Diarrheal Disease:  Guide for Training Outreach Workers.  USAID/HIP, AED, Washington DC, USA. 

Amhara National Regional State Health Bureau (2005).  Woreda Resource Book; Community-Led Total Behavior Change in Hygiene and Sanitation. The Amhara Experience in Line with the Health Extension Program. Amhara National Regional State Health Bureau supported by WSP, USAID and HIP.  http://www.wsp.org/UserFiles/file/Amhara_Woreda_Community_Led_Sanitation_Hygiene.pdf  Accessed March 2010.

Favin, M. (2004).  Promoting Hygiene Behavior Change within C-IMCI: The Peru and Nicaragua Experience.  EHP, Washington DC, USA.  http://www.ehproject.org/PDF/Activity_Reports/AR-143CIMCI%20-format.pdf Accessed March 2010.

Favin, M., Naimoli, G. and Sherburne, L. (2004).  Improving Health through Behavior Change, A Process Guide on Hygiene Promotion. Joint Publication 7. USAID, PLAN and WHO.  Washington DC, USA. http://www.ehproject.org/PDF/Joint_Publications/JP007-CIMCIProcessGuideWeb.pdf  Accessed March 2010.

Kleinau, E.; Post, M. and Rosensweig, F. (2004). Advancing hygiene improvement for diarrhea prevention: lessons learned. Environmental Health Project (EHP), Washington DC, USA. http://pdf.usaid.gov/pdf_docs/PNADA451.pdf  Accessed March 2010.

Sorti, C. (ed). (2004).  The Hygiene Improvement Framework A Comprehensive Approach for Preventing Childhood Diarrhea.  Joint Publication 8.  EHP, UNICEF/WES, USAID, World Bank/WSP, WSSCC. http://www.ehproject.org/PDF/Joint_Publications/JP008-HIF.pdf   Accessed March 2010.

USAID (2004).  Preventing Childhood Diarrhea Through Hygiene Improvement.  Pamphlet produced by EHP, USA – adapted from Joint Publication 8. http://www.ehproject.org/PDF/Joint_Publications/JP0013-HIFPhamplet%20PS.pdf  Accessed March 2010.

Bateman, O.M. et al. (2002). Prevention of Diarrhea Through Improving Hygiene Behaviors.  EHP-CARE-ICDDR/B, EHP Joint Publication No. 4.  Washington DC, USA.

McGahey, C. (2001). Urban Environmental Health Pilot Activities: Evaluation of Progress and Lessons Learned. EHP Activity Report 116. Washington DC, USA.

Saadé, C. Bateman, M. and Bendahmane, D.B. (2001).  The Story of a Successful Public-Private Partnership in Central America: Handwashing for Diarrhoeal Disease Prevention. Published by the Basic Support for Child Survival Project (BASICS II), the Environmental Health Project, the United Nations Children’s Fund, the United States Agency for International Development, and The World Bank, USA http://www.ehproject.org/PDF/Joint_Publications/JP001CentAmHandwash.PDF    Accessed March 2010.

Resources

This article is linked to the article on Environmental Sanitation Planning for the Urban Poor. Other related sections are:

This collection of atricles were contributed by Elizabeth Tiley (project officer at Eawag) and Andy Peal. The issues and topics addressed are based on the title, Hygiene and Sanitation Software: An Overview of Approaches, by Andy Peal, Barbara Evans,and Carolien van der Voorden.

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  XWiki.beddowve   Victoria Beddow