Revising hygiene kit contents for COVID-19
During the COVID-19 pandemic, it may be advisable to increase the amount of soap and cleaning products that are being provided to families. If there is more soap and cleaning products available via hygiene kits, then people will use these resources less sparingly and the frequency of hygiene practices may increase. There are already many good examples of hygiene kit provisions being increased in camps in Ethiopia, Kenya, Uganda and Tanzania in response to COVID-19. Distributing good quality hygiene kits, with sufficient soap, has been shown to have an important impact on disease transmission in other outbreaks particularly when combined with hygiene promotion.
Prior to increasing the supply of soap or other hygiene items within kits consider the following:
Sustainability - Make sure you can maintain this throughout the outbreak (assume enough supply for 6 months for an average size household in your context).
Standard kit items - Also make sure you are still able to provide all other basic components of hygiene kits in your context.
Broader effect on markets - Consider doing a Rapid Market Assessment to ensure that your organisation’s procurement will not have a detrimental effect on product pricing or the broader market availability of soap or other cleaning products, given that soap is likely to be in high demand throughout the COVID-19 response (see some example tools here from UNHCR and Oxfam).
Selecting soap - All types of soap are effective for preventing the transmission of COVID-19. There is no evidence that antibacterial soaps are more effective under normal use conditions. However when deciding what soap to provide, make sure that it is not harsh on hands. In other crisis affected settings, nicer quality soap was reported to facilitate good handwashing practice.
Selecting cleaning products - When adding cleaning products to hygiene kits, specialised cleaning products are not necessary during this time, and standard bleach-based products or disinfectants should be sufficient.
Example of an unadjusted UNICEF hygiene kit asused for emergency response in the Philippines.
If alcohol-based hand rub is available in your country, consider including this in hygiene kit distribution. However make sure people understand that handwashing with soap and water is just as effective at removing and killing SARS-CoV-2. Alcohol-based hand rub must contain at least 60% alcohol in order to be effective.
Depending on the set up in the camp or community, distribution of materials to individuals or groups (e.g. members of WASH committees) to enable cleaning of communal areas and toilets may also be needed. This may include some basic PPE such as rubber “marigold” type gloves (these should be disinfected after each use and hands should be washed with soap) or disposable gloves (these should be disposed of safely after use and hands should be washed with soap), masks, additional cleaning products (such as bleach-based cleaning agents) and greater access to water.
Rubber gloves, also known as “Marigolds”
Making distribution processes safer
There are a range of measures that can be taken to make hygiene kit distribution safer for staff and communities. If you make changes to distributions make sure to communicate these changes widely. This is important because people may panic or be tempted to break the new guidelines if they perceive that there is a limited stock of items.
In all cases distributions should ensure that basic hygiene and physical distancing measures are followed.
Handwashing facilities - Make sure there is a handwashing facility with soap and water at the location where people are collecting kits. Encourage community members to wash their hands with soap when arriving at the distribution area and after signing for their kit (this should minimise the risk of contamination from signing for receipt of the kits). Encourage staff to wash hands frequently during distribution.
Physical Distancing - use simple approaches to put in place physical distancing cues. This should include measures to make sure individuals in the cue stand 2m apart and should establish a one-way system for entering and leaving the area. You can use simple visual cues such as signs, or create markers or circles on the ground. For example, the image below shows different coloured sand being used to create physical distancing measures in a camp.
Protective equipment for staff - Staff should have access to basic protective equipment such as masks and gloves. Read our guidance about how to use these items safely. Also make sure staff maintain physical distancing between each other and between camp residents.
Source: ACF Nigeria
The following practical suggestions for hygiene kit distribution may be relevant to your setting depending on physical space available and the stage of the outbreak in your country.
Smaller group distribution - Adapt distributions so that they take place in locations throughout the camp or community to reduce the need for people to travel and so that they only require smaller groups of people to come together in one location.
Allocate time slots - minimise the need for everyone to attend the location at once by allocating and communicating time slots throughout the day. One way of doing this is to call different camp blocks or neighborhoods at a specific time or distribute tokens that can only be redeemed between certain hours. In communities you may also be able to use house numbers to allocate times (e.g. anyone with a house number ending in 1 should attend distribution points between 9am - 10am). Note that for protection and safety reasons we suggest that distributions are only done during daytime hours.
Moving distributions to open spaces - make use of any available open spaces. This may include unused land around the perimeter of the camp or spaces that are not being utilised during the outbreak such as schools or meeting spaces. However avoid doing distributions inside.
Door to door delivery - in some camps it might be possible to deliver hygiene kits door to door with vans. This is likely to be necessary as the outbreak progresses in order to allow for sick individuals to remain in isolation. Staff should not enter households and if interacting with families should remain outside at a distance of 2m.
Ensure that only one person from a household collects the kit - Ensure that the kit can be easily collected and managed by one person. If kit size is dramatically increased then this may require more than one person to collect and carry the items, which should be avoided at this time.
Given that the measures outlined above may be different to your standard programming, it might be useful to conduct a simulation or pilot of the revised distribution process prior to rolling it out more widely.
The UNHCR, IOM and the Inter Agency Standing Committee have all developed guidance for COVID-19 prevention in camps and camp-like settings. These include further information on the distribution of hygiene kits.
Doing hygiene promotion in combination with hygiene kit distribution
As the COVID-19 outbreak progresses it will become increasingly difficult to conduct in-person hygiene promotion sessions. Since people may have to continue to visit distribution points this is an opportunity to share information at these sites. In these sites we suggest using static and interactive hygiene promotion approaches.
Handwashing on entry and departure - this will help position handwashing as a key preventative behaviour and something that is the new norm within the camp or community distribution point.
Physical distancing cues - make sure you put in place simple cues in the physical environment to encourage people to stand 2m apart. These can be stickers, dots painted on concrete, stones or pieces of wood that are dug into the ground, or circles made from different coloured sand.
Billboards or posters - If people are spread out in a physically distanced line awaiting their kits, then place billboards or posters along the line so that people have something to engage with while they wait. When designing these make sure to use lots of imagery (to overcome potential illiteracy) and keep wording to a minimum and in all locally spoken languages. Posters could cover transmission, symptoms and preventative actions. However, consider other more creative options too. For example you could create a sense of transparency by adding an updatable board with information about cases confirmed, cases being treated, cases recovered in the local area. You could also add information about provisions (e.g. X number of additional hand washing facilities have been constructed or next kit distribution is expected on X date). Alternatively use these posters to convey non-health messages which are encouraging, positive and create a sense of community spirit.
Hygiene promotion whilst people queue for distribution - while people are queuing seize the opportunity to do hygiene promotion activities. This could include explaining the posters or billboards as described above but could also include simple ‘experiment-like’ activities which may have a stronger behavioural impact. For ideas on how to do this see our article on practical actions for handwashing promotion. Combining hygiene promotion with kit distribution was found to be effective in Bangladesh during a cholera outbreak.
Communication materials in kits - Consider adding pamphlets or posters about COVID-19 into kits. These could also cover topics like transmission, symptoms and preventative actions but may also include practical advice about the new situation - e.g. tips for cleaning. When designing these pamphlets make sure they include lots of images. Think about whether they would make sense to someone who is illiterate. If you are including posters, think about how they could be made more decorative so that people are more inclined to display them. An example might be to include a large image of a strong, happy and healthy family and then include a section below with key behaviours that can help keep people healthy.
Make sure physical distancing is maintained when people queue for distribution. Source: Ministry of Health Kenya
Redesign what hygiene promoters wear - Normally humanitarian organisations each wear organisation branded clothing. At this time it may be more important than normal to convey that all organisations are working in a harmonsed manner and are implementing measures which may seem strange but are for everyone’s benefit. Consider producing t-shirts that say something like ‘We are all in this together’ or ‘together we can beat coronavirus’ and have a visual image which depicts this.
Public screens - Consider setting up large TV screens which share messages about COVID-19. While content shown should be educational, it may be more powerful if they also tell a story or appeal to aspirational ideas. For more information on this see our article on what influences hygiene behaviour.
Add in rewards - Practicing hygiene behaviours and physical distancing will not be easy in camp or densely-populated community settings. So it is important to recognise the sacrifices people are making and reward them for doing the right thing. Consider adding small gifts and thank you notes into each hygiene kit. For example this could simply involve wrapping up the additional bars of soap in wrapping paper and adding a bow as if they were a present. Add a gift tag that says something like ‘Thanks for doing the right thing. Keep it up’
Learning from your community - While people are queuing can be a great time for hygiene promoters to speak with members of the population. Develop structured and informal ways to understand current perceptions, answer common questions and get feedback on their programming and what makes things easier. You can prepare your hygiene promoters with a series of frequently asked questions and ideal responses to help them answer questions from the population.