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Summary report: Changing hygiene behaviour through products
Summary report: Changing hygiene behaviour through products
Astrid Hasund Thorseth avatar
Written by Astrid Hasund Thorseth
Updated over a week ago

Access and use of hygiene products are key consumable inputs to enable the practice of preventative behaviours for prevention of transmission of enteric and respiratory diseases. The recent COVID-19 pandemic has resulted in increased demand for soap and alcohol-based hand rub (ABHR) worldwide, leading to shortages in some areas.

In this document we outline factors to consider if your organisation is thinking of making soap or ABHR, and what to consider when revising hygiene kit contents.

What is soap made of?

Soap is made by combining liquid, oil or fat and sodium hydroxide, better known as lye. Once you have the ingredients at hand, the process of making soap takes a couple of hours. However, following production, the soap needs to be cured for 4-6 weeks before it can be used. There are also several safety considerations that must be taken into account when making soap, meaning soap making may not necessarily be a quick solution to increase the soap supply for your infectious disease.

Is soap making the right thing to do in my context?

If you are considering making soap, first consider the following factors:

  • Safety. Do you have the personal protective equipment (PPE), utensils and work space necessary for handling caustic chemicals? There are risks involved in making soap. For example, lye is a caustic material (meaning it will damage other substances it comes into contact with, including clothes and skin) and must be handled with caution. Proper safety equipment such as thick rubber gloves and safety glasses must be worn throughout the mixing process.

  • Objectives. Consider why you are making soap for your disease outbreak response. Are there other suitable commercial products available and affordable (all types of soap will effectively remove and kill pathogens). Are there existing companies or factories that would be better placed to scale up production? Will this be a sustainable initiative or are you setting it up solely for your disease outbreak response?

  • Local practice and use. Consider what types of soaps are already used by the community. Will a locally made soap be accepted?

  • Availability of materials. Do you have access to sufficient supplies of Personal Protective Equipment (PPE), and the ingredients and equipment needed to make soap?

  • Urgency. Is the need for soap urgent? Making soap takes a minimum of 4 weeks, so if you need the soap sooner than this you might want to consider other alternatives like purchasing and transporting soap from elsewhere in the country, importing soap, or promoting alternatives to soap.

  • Costs. Consider the cost of commercially available soap and compare it to the cost of producing soap locally. Think about costs of equipment, raw materials, labour and transportation. If local production is more expensive there may not be an incentive to produce soap locally.

If there are viable alternatives available to making soap, such as preparing soapy water for handwashing or procuring commercial soap, we recommend these options over making soap yourself.

How do I make soap?

Before you make soap, read about how soap works. We describe here how to make soap in a low resource setting using a cold process. These instructions are adapted from this resource and explains how to make 4 kg of soap using palm oil as an example. Options for oil in soap making include liquid oils, semi-solid oils, and lauric oils (as listed below). Palm oil is not always harvested responsibly, so do take precautions when purchasing this – i.e., determine where it is sourced from, methods of harvesting which addresses deforestation risk. We have chosen palm oil as it makes a hard and long-lasting bar of soap that generates a lot of lather. It is possible to make soap on your own, but we recommend using at least two people to make the process easier.

Equipment

  • Thick rubber gloves

  • Safety glasses

  • 3 large glass or plastic bowls or plastic buckets (these must be solid or heavy duty)

  • Measuring cups

  • 3 large silicone spatulas/large plastic spoons/large wooden spoons

  • Weighing scale

  • Water-tight moulds (made from plastic, wood, cardboard or waxed paper). You can also use silicone moulds

  • Knife or wire to cut the soap

  • Cloth, waxed paper (e.g. baking paper) or plastic bags to line the mould (if not a silicone mould) so that the soap can be removed from the mould easily.

Equipment required for making soap. Source: various

10 rules for safe soap making

  1. Always wear thick rubber gloves.

  2. Always wear safety glasses to protect your eyes when you are handling lye.

  3. Always wear long-sleeved clothing, long pants/trousers and covered shoes (no sandals).

  4. Avoid inhaling fumes when you mix the lye in the liquid by working in a well-ventilated room and covering your mouth and nose with a mask or scarf.

  5. Use wood, glass or plastic utensils and pots to prepare soap. Do not use metal as this can react with the lye and cause an explosion.

  6. After using utensils for soap preparations they should never be subsequently used for handling food.

  7. Use a disposable tablecloth or newspaper to cover your table or bench when preparing soap - throw these away once you have finished.

  8. Make sure you have running water available near your workstation. In case of direct contact with lye, rinse immediately and contact your doctor.

  9. When cleaning up after you have finished making the soap, continue to wear rubber gloves and safety glasses at all times as raw soap is caustic and dangerous. Dispose of the tablecloth safely.

  10. Keep lye and raw soap out of reach of children and pets at all times.

Ingredients

1. Lye

Measurement: 370 grams/ 13.05 oz

There are two types of lye that you can use: 1) sodium hydroxide (NaOH), also known as caustic soda, or 2) potassium hydroxide, also known as potash. Sodium hydroxide is the most commonly used. Lye is a highly caustic product. If you choose to use potassium hydroxide, please note the measurements will be different. You can use a soap calculator to get the exact measurements. Lye can be purchased from most pharmacies.

2. Water

Measurement: 1.2 litres/ 1095 grams/ 38.65 oz

Use distilled water if available. Other options of “soft” water (not containing chlorine) include bottled water and filtered water. You can also use rain or spring water.

3. Fats

Measurement: 3 litres/ 2740 grams /96.62 oz of palm oil

You can use any of the fats or oils listed below. If you choose to use other types of oils rather than palm oil, please note that the measurements will be different. You can use a soap calculator to get the exact measurements.

Liquid oils

Palm oil, olive oil, corn oil, sunflower seed oil, fish oil, groundnut oil, soya bean oil, cottonseed oil, coffee bean oil, moringa oil

Semi-solid fats

Palm oil, castor oil, aloe butter, beeswax, animal fat or shea butter

Lauric oils

Coconut oil or palm kernel oil

Step 1: Prepare your work station

  • Set up your soap-making workspace in a well-ventilated room or outside.

  • Prepare your work station by removing any unnecessary objects and covering the work surface with a disposable cloth or old newspapers.

  • Prepare the mould. If you have a wooden or hard plastic mould you should cover this with baking paper or a plastic bag.

  • Lay out all of the equipment you need so it is at hand when needed.

  • Before starting, familiarise yourself with all steps of the recipe and ensure that you have all ingredients and equipment at hand.

Step 2: Measure your ingredients

  • Make sure you are wearing full PPE as listed in the ‘10 rules for safe soap making’ section above.

  • Ensure there are no children or animals in the room so that you will not be disturbed.

  • Firstly, measure the water using a measuring jug and pour into one of your mixing bowls. If you do not have access to a measuring jug you can use a clean 1L plastic bottle (you need 1 and ⅕ bottle fulls)

  • Measure 3 litres of oil and pour it into a second, large bowl.

  • Measure the lye using a weighing scale and add to your last empty bowl. Note: accurate measurements are important for a successful result.

Step 3: Mix the lye and water

  • Pour the lye slowly into the water while stirring. Note: never do this the opposite way (i.e. add the water to the lye) as this may cause an explosion.

  • Stir continuously until the lye is completely dissolved in the water. This solution will heat up so, once the lye is completely dissolved, leave it cool.

Step 4: Mixing the lye/water mixture and oil

  • Make sure the lye/water mixture and the oil is approximately the same temperature by touching the outside of the bowls.

  • Add the lye/water mixture to the oil while stirring.

  • Continue to stir continuously and carefully until it thickens, this process takes up to 30 minutes.

  • You can tell when you have stirred the soap enough by drizzling a spoonful of mixture over the surface layer - if it leaves a pattern similar to that in the photograph below you have stirred enough.

Picture: Source

Step 5: Put the soap into the mould(s)

  • Pour the soap into the mould (or moulds if you are using multiple smaller moulds) directly from the bowl. Alternatively you can use a ladle.

  • Cover the mould with plastic foil and then wrap with a towel or cloth tucked under the mould to protect it from dust. Leave the mould somewhere it won’t be disturbed.

Step 6: Setting the soap

  • Leave the soap to set for 24-48 hours.

  • Remove the soap from the mould and use a sharp knife or wire to cut the soap into bars.

  • Place the soap bars standing up and leave to cure (this is the process in which the soap hardens) for 4-6 weeks.

Step 7: Using your soap

  • After 4-6 weeks of curing, your soap is ready to use!

Common problems when making homemade soap

If your soap is dry or crumbling, it is possible that you have used too much lye.

  • Soap needs to stay in the mould for at least 24 hours. If the soap is still soft, leave it in the mould for up to 10 days. If the soap is still soft after 10 days it is unlikely to harden.

  • The oil or fat you used was dirty or rancid disturbing the curing/setting process of the soap and giving an undesirable result.

CAWST offers print-friendly materials for making soap and for teaching others how to make soap in English, French and Spanish. Another recipe for making soap in a low-resource setting is offered by the Pace Project (English only).

How do I make alcohol-based hand rub?

Alcohol-based hand rub (ABHR) is as effective as handwashing with soap against many pathogens including the SARS-CoV2 virus, but can be less widely available and often more expensive. Moreover, hand washing with soap eliminates all types of germs, as well as harmful chemicals, whilst ABHR does not. Nonetheless, ABHR may be recommended in:

  • · Health-care facilities

  • Situations where access to soap and water is limited or more expensive to access

  • Where there is a need for rapid and effective decontamination of hands

Local production of ABHR is recommended by the World Health Organization (WHO) only if there are no other suitable commercial products available or they are too costly. If you choose to produce ABHR locally, follow this guide by the WHO.

Adapting hygiene kits for disease outbreak responses

Revising hygiene kit contents

As a general principle, hygiene kits should be in line with Sphere Standards and national government or WASH Cluster guidelines that are adapted to include products which are locally acceptable.

During an outbreak, it may be advisable to provide directly and increase the amount of soap and cleaning products that are being used by 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 many examples of hygiene kit provision being increased in camp, urban and rural settings in response to infectious disease outbreaks. For instance, during the COVID-19 pandemic, the FCDO and Unilever convened The Hygiene & Behaviour Change Coalition, which distributed 69m bars of soap to 60 countries across six regions, focusing on areas that lack access to essential hygiene products. Behaviour change interventions such as the “PASSWORD” campaign, and Magic Hands promoted hand hygiene and use of distributed soap.

Distributing appropriate and good quality hygiene kits, with sufficient soap, has been shown to have a significant impact on disease transmission in many outbreaks - such as this cholera epidemic in Bangladesh - 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 in question (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 - Conduct a Rapid Market Assessment to determine quality, quantity and cost of hygiene items available on the local market. If in-kind distributions are recommended, 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 response (see some examples of tools and market monitoring here from Global WASH Cluster. UNHCR, Joint Market Monitoring Initiative, CaLP and Oxfam).

  • Selecting soap - All types of soap are effective for preventing the transmission of pathogens. 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 crisis affected settings, higher 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, and standard bleach-based products or disinfectants should be sufficient.

Example of a standard UNICEF hygiene kit as used for emergency COVID-19 response in the Philippines. Source: UNICEF

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 pathogens. Alcohol-based hand rub must contain at least 60% alcohol in order to be effective.

The distribution of surgical masks or N95 respirators are also recommended during outbreaks of some respiratory diseases, such as COVID-19 , providing that there is availability after they have been distributed to priority groups, namely health staff and patients, carers, the elderly and people with disabilities.

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”. Source: Provac

Making distribution processes safer – example of COVID-19

There are a range of measures that can be taken to make hygiene kit distribution safer for staff and communities during infectious disease outbreaks. If you make changes to distributions, ensure that you 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.

The measures that you put in place will depend on the transmission route of your focal disease. Here, we use COVID-19 as an example, though the activities can be adapted for other infectious diseases with similar modes of transmission. During COVID-19 outbreaks, distributions should ensure that basic hygiene, mask wearing, and physical distancing measures are followed.

  • Handwashing facilities - Make sure there is a handwashing facility with soap and water at the location (entrance and exit) 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.

  • Mask wearing - When you communicate the planned distributions of hygiene items, ensure the community are aware that masks should be worn during distributions. This should be informed by Government policies at the time, and not inhibit communities in collecting their hygiene items. Practical measures, such as a scarf, balaclava, or bandana can go along-way in being effective and accessible.

  • Physical Distancing - Use simple approaches to put in place physically distanced queues. This should include measures to make sure individuals in the queue stand 1m 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 neighbourhoods 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 and communities 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, and ones who are shielding. Staff should not enter households and if interacting with families, should remain outside at a distance of 1m.

  • 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 where appropriate.

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 WHO, 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

Since people may have to continue to visit distribution points, during disease outbreaks, this is an opportunity to share information at these sites. In these, sites we suggest using static and interactive hygiene promotion approaches. Whilst the suggestions below were written with COVID-19 in mind, they can also be applied to other infectious diseases with similar key preventative behaviours.

  • 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 1m 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 the focal disease into kits. These could also cover topics like transmission, symptoms, preventative actions, and information on the vaccine (if applicable), but may also include practical advice about the new situation - e.g. where, and when to get the vaccine, and risk of new variants emerging. 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. During outbreaks, it may be more important than normal to convey that all organisations are working in a harmonised 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 the focal disease. 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. Oxfam and ACF adapted their COVID-19 programme interventions based on the findings from perceptions collected via a community perception tool (CPT) – as highlighted in the two cases studies – ACF in Zimbabwe and Oxfam in Lebanon. You can prepare your hygiene promoters with a series of frequently asked questions and ideal responses to help them answer questions from the population.

Editor's note

Author: Astrid Hasund Thorseth and Sian White

Last update: November 2022

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