Developing the UNICEF Malawi School Handwashing Program

Diarrhea is one of the major causes of morbidity and mortality among children and immune-compromised individuals in Malawi. Handwashing with soap (HWWS) is one of the most cost-effective health interventions to prevent diarrhea. United Nations Children’s Fund (UNICEF) Malawi has adopted a social marketing approach to achieve large-scale behavioral change for HWWS. The study, commissioned by UNICEF Malawi, was developed by PSI Malawi and Griffith University and conducted by PSI Malawi. Formative research insights using two research studies are presented including observations at 30 primary schools in terms of HWWS behavior. Second, key informant interviews with school administrators and staff members were conducted to understand HWWS motivation, opportunity, and ability factors. This study found less than half of the assessed schools had handwashing facilities. Structural barriers that prevent school children from practicing HWWS were identified including a lack of financial resources to construct permanent handwashing facilities in schools. Many schools also experience a lack of support from the community as citizens are not aware of the benefits of HWWS. Changes to school and community infrastructure are required to facilitate the adoption of the behavior. Supporting activities to encourage school children to practice HWWS and reinforcement strategies to sustain the behavior over time should also be implemented. School children can then become change agents for HWWS by reinforcing the behavior at home thereby contributing to the achievement of the national objectives to reduce diarrhea and leading to improved health and well-being for communities in Malawi.