In this summary report we reflect on how programmes can be adapted given the protracted nature of the COVID-19 response. This includes building in mechanisms for sustainability and advocating for longer term programmatic, policy and systems changes. This summary report presents key principles that can be drawn upon to influence contextualised approaches to sustainability, advocacy and policy change.

Why should programmes be adapted and strengthened based on pandemic experiences?

In this section we outline some of the reasons why all COVID-19 programmes need to build in mechanisms to allow adaptation.

Adaptive programming can enable programmes to be more effective and responsive to local needs.

Adaptive programming improves existing programmes by modifying them as necessary in response to changing contexts. By adapting programmes to reflect the local realities, it is more likely that public health and WASH programmes will remain relevant. Adaptive programming is especially important to consider when scaling up programmes to ensure they remain effective in achieving behaviour change for the target population. Therefore, adapting programmes throughout the course of their implementation is considered good practice. Adaptive programming is also important if you are undertaking advocacy or policy work.

The dynamic nature of COVID-19 transmission and the changing state of evidence requires constant adaptation.

Each country is experiencing the pandemic differently, and as such, responses vary in different parts of the world and even within countries. In some settings, cases and deaths are still on a steep rise, while others are seeing a decline. There are also many countries where the number of new cases stabilized or declined initially, but there was then a ‘second wave’ of cases and deaths. The graph below shows how transmission has varied across different continents.

Image: BBC based on ECDC data up until 28th December 2020

The secondary economic and social impacts of COVID-19 will also vary by country and this may have a substantial influence over the policy decisions made by national governments. Organisations have had to regularly adapt their programming because of these changes in transmission, policy and social perceptions.

As our understanding of COVID-19 improves, prevention programmes have had to adapt.

Between January and October 2020, more than 60,000 academic publications were written about COVID-19. The speed of our learning about this novel pathogen has been unprecedented and challenging for practitioners to keep up with.

Image: Lit Covid data showing the number of academic publications about COVID-19 per week.

Recommendations around prevention behaviours have changed over time in light of increased understanding about COVID-19. For example, in the early phase of the response many countries were hesitant to recommend the use of masks among the general population. However, as our understanding of COVID-19 transmission improved and further research emerged, mask use was recommended by the WHO and has since been central to the COVID-19 response in most nations. In contrast, in the early stages of the pandemic many countries were considering large-scale disinfectant spraying, but this has since ceased because it is unlikely to be efficacious and can pose safety risks. Other prevention behaviours like handwashing with soap and use of hand sanitisers were recommended early on, have been adopted globally and are still considered key to interrupting transmission. Accordingly, organisations have sometimes had to adapt their strategy and encourage additional behaviours among their target populations.

Adaptation is needed to move from the acute phase of response to longer-term action.

COVID-19 programming will also need to adapt as we transition from the acute, emergency response phase of programming to a more long-term response mode. As we enter this ‘long-term response mode,’ programming must pivot and consider sustainability and policy change. This will require us to:

  1. Close some of the gaps and inequities that result in some populations being disproportionately vulnerable to COVID-19: people who are clinically vulnerable (such as older people and people with pre-existing conditions), people who live and work in settings which put them at increased risk of exposure to COVID-19 (such as densely populated areas), people who are more likely to experience severe socio-economic secondary impacts (such as people living in poverty or working in the informal sector), people who lack access to water, sanitation and hygiene infrastructure, and people who have reduced access to health care or critical services.
  2. Build resilience against future outbreaks and reduce the burden of chronic public health challenges like diarrhoeal diseases.
  3. Improve and sustain efficient public health response systems at the national, institutional and community levels.

Adaptation is necessary to overcome ‘COVID-19 fatigue’ and keep programmes relevant.

Now that populations know the basics about COVID-19 transmission and prevention, it is important to change our approach to avoid disengagement. Without adaptive programming, there is a risk that the target population will get bored and may no longer consider programmes to be relevant to their lives and concerns. For example, Oxfam’s Community Perception Tracker documents community attitudes and concerns around COVID-19 in nine countries. They have found that many populations are tired of programmes that only give COVID-19 messages because the pandemic is only one of many issues they are facing. Ongoing, iterative adaptation is necessary along with the utilisation of innovative, evidence-based activities. It is important that organisations view behaviour change as a process rather than a one-off event. For inspiration in this regard, look to the private sector. Many big brands re-innovate their marketing approach regularly so as to ensure that there is constant interest and demand for their products. For example, Coca-Cola has maintained core aspects of their brand while releasing a new marketing campaign almost every year.

Adaptation to ensure programmes are inclusive.

Oftentimes rapid response programmes, including COVID-19 response programming during the early phase of the pandemic, may not be inclusive. However, with time, more data, and a better understanding of who is vulnerable, programmes can be adapted to address those earlier gaps. Programmes and national strategies are now more commonly targeting specific sub-groups of the population who are at risk. There are now resources dedicated to mapping vulnerable populations and providing more granular data to aid in response. In Kenya, the need for a more targeted response among at-risk populations has also spurred the creation of new indices to measure multiple dimensions of vulnerability (e.g. social, epidemiological) and inform programming. More diverse types of data are also needed to understand the perspectives of different population sub-groups and how the pandemic may have affected people in different ways. Working with groups that represent vulnerable groups (e.g. Disabled Person’s Organisations) can be key to developing successful and acceptable programme adaptations.

Programming also needs to tackle and confront any discrimination and stigmatisation that is observed during response efforts. The fear created by the pandemic can prompt people to blame minority groups as they search for explanations during these uncertain times. This can mean that people of certain ages, genders, religions, ethnicities, castes, socio-economic backgrounds or those who belong to certain professions, become unfairly stigmatised. Adaptive programming necessitates that response actors closely monitor messaging, images and approaches to ensure they are not inadvertently fuelling discrimination.

Keeping communities informed as you adapt

Communities should be informed about policy changes and changes in your programming in order to allow them to make necessary changes in their lives. Information dissemination should be regular and concise in highlighting key milestones in the progression of the pandemic and the ripple effects in programming. For example at the beginning of the pandemic in Zambia, the guideline was for those with COVID-19 symptoms to call a COVID-19 response hotline and not go to the public health facility. However, with time and after prevention and diagnosis measures have been strengthened at the health facilities, people can now go to their local health facility for testing. These and other changes should be communicated in a timely manner and coordinating institutions should ensure messaging is consistent among themselves to avoid misinformation or unnecessary uncertainties.

What do we know about the sustainability of hygiene programmes?

There are multiple dimensions to consider if hygiene programmes are to be sustainable: the sustainability of behaviour, infrastructure, services and systems. Each of these components reinforce each other.

Image: Hygiene Hub

1. Sustaining behaviour change: To increase and sustain hygiene behaviours, such as handwashing or mask-wearing, we need to consider whether people are likely to continue to practice the behaviours after active promotion comes to an end. Two systematic reviews of hygiene-related behaviour change address sustainability, and both conclude that evidence about the sustainability of behaviour change programmes is limited (Study 1, Study 2). One of the reviews explored factors that influence sustained WASH behaviours, but it was unable to draw conclusive findings. However, the factors outlined below are likely to be important for the adoption of handwashing behaviours during the programme period and sustaining them after the programme ends:

  • Knowledge alone doesn’t enable sustainable behaviour change – Interventions employing one-way communication with the intention of increasing knowledge or skills surrounding hygiene were not found to have any effect on sanitation outcomes nor lead to any sustained change in handwashing behaviour.
  • Design programmes based on theory and address determinants of behaviour – Interventions based on theory are more likely to increase handwashing behaviour change. Behaviour change interventions which combine psychosocial theory with an enabling environment are more likely to increase handwashing behaviour change and facilitate handwashing station maintenance. Addressing a range of determinants of handwashing, rather than just a few factors, will also likely lead to sustained changes.
  • Promote community ownership, leadership and supportPsychological and community-level resources (e.g. social support from the family and community) can help enable behaviours. Community engagement in running the program, from planning to design, implementation and oversight, will likely increase ownership. Some examples of community-based approaches for WASH interventions include Community Led Total Sanitation (CLTS) and Participatory Rural Appraisal (PRA) approaches which have a sanitation component. To make it possible for behaviour change to be sustained, a sufficient ‘dose’ of the intervention needs to be achieved. Achieving sufficient ‘dose’ requires programmes to reach and engage their target populations enough times to achieve an effect, therefore requiring community engagement over time. It also requires programmes to consider the best ways of reaching all members of a society. Utilising multiple delivery channels can also help in achieving a sufficient ‘dose’ and enabling programmes to be effective at changing behaviour in the short and longer-term.
  • Work towards longer-term habit formation – For a behaviour to become a habit it needs to move from something that we consciously think about to something that is semi or fully automatic and done in response to familiar cues. Creating an enabling physical and social environment can therefore contribute to habit formation. Including signs or nudges about when to practice the behaviour and mandatory handwashing or mask-wearing in institutional settings can facilitate behaviour change. A habit-enabling environment normally requires: a) a stable, unchanging setting where the behaviour takes place, b) continued access to the necessary products required to perform the behaviour, c) an existing routine or series of actions into which the new, desired behaviour can fit into, and d) adjusted perceptions of social norms related to these behaviours. Visual cues can remind people to practice hygiene behaviours. Legal and regulatory interventions may promote lasting behaviour change in the interest of public health. Laws limiting the sales of tobacco products to minors, restricting smoking in public places, and mandating the wearing of a seatbelt while driving are some examples of how regulations can influence public health outcomes and lead to long-term changes of behaviour.
  • Address motivators for behaviour – Motivators such as enjoyment and satisfaction from handwashing, self-determination, and identity can contribute to sustained behaviours. People may experience sensory rewards from practicing hygiene behaviours, such as having pleasant smelling hands after washing them with soap. The SuperAmma campaign to promote handwashing behaviour in Southern India is an example of how motivators can be leveraged to change behaviour, such as a mother’s motivation to nurture her child and ensure their future success. Another study conducted in Nepal, Pakistan and the Philippines explored other emotional motivations for handwashing behaviour, including shame and respect.
  • Leverage local norms – It can take time to change social norms. However, it can be relatively easy to change normative perceptions (i.e. people’s perceptions of what people do or how others should behave) and this in turn can contribute to behavioural change. Norm-based messaging can draw attention to the behaviour of others and make people more aware that others pay attention to their behaviour. There is evidence that individuals are more likely to practice handwashing behaviours when they are being observed or are in the presence of others. However, handwashing may often take place in settings that are private or hard for others to observe behaviour (e.g. bathrooms). To overcome this, other mechanisms within programmes can draw attention to normative behaviours, such as showing people washing their hands and adopting prevention behaviours on social media or television. One study conducted in Ethiopia found that people with strong injunctive norms (behaviours that are approved or disapproved by others) and descriptive norms (behaviours that are practiced by others) were more likely to practice handwashing behaviour, and suggested that an intervention requiring a public-commitment to wash hands would help promote both types of norms and likely lead to increased handwashing.

The table below is based on a systematic review of handwashing and sanitation behaviour change interventions and gives an overview of how uptake, adherence and sustainability are likely to vary between interventions. Community based approaches and interventions based in theory are more likely to result in uptake and adherence, but still do not have enough evidence to support sustainability.

Adapted from De Buck et al.

2. Sustainable enabling technology: Sustainability may not be possible if the behaviour is not convenient and easy to practice. Having infrastructure in place is key for ensuring the behaviour can be convenient, and therefore having an ongoing supply of products to maintain the infrastructure is essential (Study 1, Study 2). If programmes involve the provision of infrastructure or encourage communities to invest in infrastructure that enables behaviours (such as handwashing stations in homes, health facilities and public places), then it is important to consider how to put in place a system for maintaining this technology. This resource explains how the design of handwashing facilities can have an impact on handwashing behaviour. Desirable facilities are more likely to be utilised and maintained. During COVID-19 there has been a dramatic scale-up in the number of organisations investing in handwashing facilities in public places. WaterAid and the Sanitation Learning Hub have developed guidance on public handwashing facilities, and both cover important steps for enabling the ongoing operation and maintenance of these facilities. The sustainability of handwashing facilities needs to be considered from the outset. This should include involving the target population in the design of the facilities to ensure that they are acceptable, desirable and accessible for everyone to use. Sustainability can also be improved by constructing the facilities from materials that are durable, or which can be replaced easily and locally. They also recommend establishing an operation and maintenance plan with local institutions or communities and set out roles and responsibilities in relation to who should fund, purchase and refill the soap and water, who should clean the facility (and how it should be cleaned), and who should fix the facility if it is broken.

3. Building sustainable services: Some behaviours, like handwashing with soap, require infrastructure, products and access to services such as a regular water supply. The pandemic has drawn attention to long-standing global inequities in water access and to the importance of promoting inclusive services which provide water for all sub-groups of the populations (e.g. including those in rural locations, who are displaced and living within camps or people with disabilities). During the pandemic, governments and water service providers in many regions adapted their services and put in place mechanisms to enable populations to access more water or make it more affordable. For example, some governments in Africa drilled additional boreholes or organised short-term, water trucking services to water scarce communities. Other countries have waived water bills or provided water subsidies during the pandemic. As COVID-19 response funding reduces or response initiatives wind down, it is important that we don’t see a return to the status quo. A coordinated systems approach will create lasting change. This may require actors to develop a better understanding of water vulnerabilities by mapping access and the regularity of water supply. Such information can be a vital tool for advocacy and the prioritisation of longer-term investment in water infrastructure. Secondly, it will require governments, community organisations, donors, NGOs and consumers to develop strategies and plans which actively work towards more sustainable water services. UNICEF’s Framework for Programming for Sustainability in Water Services outlines a pathway for actors to achieve this.

4. Building sustainable systems: During outbreaks, coordination between non-government response actors and governments is often suboptimal. However, past outbreaks have demonstrated that as the response progresses into a more protracted phase, these coordination systems also mature. Transitioning from the acute phase of the COVID-19 pandemic requires coordination of mechanisms, strategies and policies and even individual programmes are reviewed and adapted with sustainability and system-level changes in mind. COVID-19 created a ‘shock’ to international health systems and at the same time has created an opportunity to build more resilient health systems in the long term. Resilient health systems would be able to identify, prevent or mitigate the spread of future outbreaks and reduce the impact of chronic health challenges like diarrhoeal disease. This article explains that responding to such a health system ‘shock’ requires improvements to health information systems, funding/financing mechanisms and the health workforce. Realising these changes requires advocacy to highlight gaps in the health system and develop policies and strategies to address them. Many COVID-19 programmes have also been ‘vertical’, meaning that they only prevent or treat COVID-19. At this point in the pandemic, it is key that programming shifts to be more ‘horizontal’, meaning that COVID-19 prevention activities are integrated within other ongoing aspects of health programming. This is more likely to lead to health-system strengthening and allows for the continued provision of health and hygiene services without interruption or any decrease in quality.

How can organisations build sustainability mechanisms into current COVID-19 programmes?

When implementing hygiene behaviour change programmes, it is important to understand that it is a process rather than a one-time event. Short-term projects are unlikely to lead to sustainability, so instead it is worth creating and investing in long-term strategies. Here are some recommendations to help sustain programme management of current COVID-19 programmes:

  • Integrate current work with other sectors: Increased inter-sectoral collaboration can lead to an increased impact on a shared target population. COVID-19 is affecting people in numerous ways beyond their physical health, whether it be their mental health, education, nutrition or livelihood. Designing, or adapting your program to address multiple challenges and integrating your response with other sectors can provide a more comprehensive system to support the population and make health and hygiene components more feasible and acceptable. A systematic review that looked at which factors facilitated programme sustainability identified having partnerships with various stakeholders as being important in ensuring the sustainability of a health programme.
  • Design programmes to complement and in turn, shape government strategies: Government-led initiatives are more likely to be sustained if they have the support of outside organisations. When organisations work alongside the government in implementing programmes, it is also more likely that the government will see the value in continuing the programme and their commitment to it. An example of a successful government-NGO collaboration is tuberculosis control in Bangladesh where greater coverage and access to necessary services was achieved. In southern Africa, programmes for orphans and vulnerable children were sustained in part due to the collaboration between the government and NGOs.
  • Involve new actors: Building partnerships between the public and private sector, as well as other actors such as the media or universities, can help maintain support and progress of your programme. They also may be able to provide more resources, drive innovation and take on responsibilities. Involving new partners can require steep learning curves, and it is helpful to share a common goal but keep each actor’s roles and responsibilities clear.
  • Partner with civil society organisations: Civil society organisations are a part of the communities they serve and this allowed them to respond rapidly to the pandemic in ways that were innovative and context appropriate. Consequently the COVID-19 pandemic has encouraged many international NGOs and government agencies to strengthen their partnerships with local actors who are better placed to understand community needs and may be able to work more safely in communities than external actors. It is important that support to civil society organisations continues to be strengthened and that these organisations play a role in setting their own future agendas and contributing to resilience building.
  • Improve coordination mechanisms and develop shared strategies: Coordinating efforts and developing shared strategies between implementers helps avoid redundancies and makes it easier to achieve programmatic goals. Some responses to COVID-19, including the UN’s Global Humanitarian Response Plan, encourages coordination between international organisations, NGOs, and national governments. Coordination is most sustainable when it is government led and aligned to border national strategies. Over the course of the pandemic new coordination mechanisms have developed such as Risk Communication and Community Engagement (RCCE) working groups. It is important at this stage to review the mid and long term purpose of these coordination groups and identify ways that collaboration, learning and sharing can continue. This does not always necessitate that these new COVID-19 coordination measures need to be maintained. For purposes of sustainability, it may be much better for coordination structures to be embedded in existing and well functioning government mechanisms. For more guidance on effective government led COVID-19 response and coordination initiatives follow the tips in this article.
  • Continue monitoring and evaluation: Monitoring and evaluating your programme will make it easier to identify areas that need improvement and so that you can adapt to changing needs. Programme evaluation can also help provide information on progress and potentially programmatic impact. For further guidance on monitoring the progress of your programme see the Hygiene Hub resources on monitoring and evaluation.
  • Be transparent about programming: Transparency of information is especially important during public health crises in order to build and maintain trust, manage fear and effectively support the adoption of health and hygiene guidance by the population. Organisational transparency in terms of their ways of working and the costs associated with programming can help maintain accountability, reduce corruption, and increase efficiencies. The sustainability of short term programmes can be supported by developing clear programme manuals and sharing programme materials so that initiatives can be easily replicated or adapted by others. Honest sharing of programmatic monitoring and evaluation information can help other actors to build on programmatic strengths and learn from past mistakes, strengthening the quality of future programming.

Could the COVID-19 pandemic result in long-term hygiene policy change?

Advocacy efforts normally aim to realise policy, programmatic or sector-level changes. However for advocacy to lead to meaningful change a number of factors need to align at the right moment in time. Often this is described as the creation of a ‘policy window’. Political theorists argue that there are multiple streams that contribute to policy windows arising. Generally, policy change occurs in response to an agreed ‘problem’. Theorists like John Kingdon suggest that ‘policies’ and ‘problems’ exist as two separate ‘streams’ which are influenced by a range of historical and contextual factors and the systems within which they occur. Running alongside these two streams is third - ‘politics’. In this theoretical context ‘politics’ encompasses advocacy actors who may be pressing governments or the sector to act. The diagram below summarizes some of the factors in each stream, illustrating how these combine in a particular moment to create an opportunity for change.

Image: Saeed Shahabiand Kamran Bagheri Lankarani in Health Sector Reform Following COVID-19 Outbreak: Using Kingdon’s Multiple Streams, 2020

Some people have suggested that the COVID-19 pandemic could be viewed as a large catalyzing ‘problem’ since it has highlighted important health shortfalls and inequities. The pandemic has shone a spotlight on the fact that hand hygiene is critical for interrupting the transmission of COVID-19 as well as a range of diseases. It has also drawn attention to the historically inadequate levels of investment and planning related to hygiene programming, policies, and sustainability. Lastly the pandemic has shown that hygiene promotion and handwashing infrastructure can be rapidly scaled up with increased willingness and buy-in from all actors. The diagram below shows an adapted version of the ‘three streams’ diagram above, which highlights how hygiene related factors may need to align to create a policy window. It illustrates that realising change will require all COVID-19 response actors to actively undertake advocacy work in order to influence policy decision makers.

There are other positive initiatives that are likely to contribute to lasting change. For example in 2020 the WHO and UNICEF set up the Hand Hygiene for All initiative. The initiative is designed to champion hand hygiene at a global level and sets out plans to support countries as they respond to the COVID-19 pandemic, while also developing national hygiene roadmaps to rebuild and reimagine the state of hand hygiene for the future.

How should implementing actors advocate for sector-level change?

Implementing actors should consider advocating for policy changes throughout all phases of the policy change process, from agenda setting to policy evaluation. For policy implementation, the removal of obstacles such as financing and developing the human resources needed is very important. While advocating, key sources of information on the health and non-health impacts of hygiene programmes should be included and the economic case for health and WASH sector interventions should be made. It is expected that some advocacy strategies will need to be adapted in response to the pandemic.

In the same way that programmes are adapted over time, it is important to incorporate adaptation into your policy plans and be responsive to the changing social, economic and political landscape. In this section, we describe some tools and approaches for advocating to decision-makers and policymakers. This includes setting up an advocacy plan with creative ways to influence and persuade key actors and actions organisations can take to ensure they are in a strong position to influence policy in the longer-term.

Develop an advocacy plan: Advocacy work, just like programming, is likely to be much more successful if a clear plan is developed from the outset. The WASH in Healthcare Facilities Advocacy Toolkit includes practical guidance on how to develop an advocacy plan. Part of advocacy planning includes being clear on your specific objective, who your target audience of decision-makers are and what actions you would ultimately like them to take. To develop a clear advocacy plan the following tools can be of use:

  • Stakeholder analysis: Identifying and analysing the actors who have interest and play an important role in your issue will help determine how your programme is developed and can help gain support for the initiative. Conducting a stakeholder analysis can also help in amplifying your cause. Here is a set of guidelines that outline how to conduct a stakeholder analysis.
  • Power analysis: A power analysis may follow a stakeholder analysis and can help to identify actors who have a lot of influence, or power, over the issue your programme is meant to address. This requires identifying both actors who may be in support or opposition of your programme and analysing how to potentially gain the support of any opposers.
  • Political Economy Analysis: A Political Economy Analysis can help you to understand how change happens, identifying how best to influence change and make more politically informed decisions. This toolkit from WaterAid can be used to guide the approach.
  • Identify positive examples: If you are advocating to the government, or even internally within your organisation, it can be useful to look at the policies adopted by other governments or similar organisations and find good examples of hygiene-related policy change. Inviting individuals who led this change to speak with key decision makers could be a powerful way to motivate change and help them to view change in a way that seems feasible. Make sure to articulate why they worked well, what led to their success and what about the case study could be replicable within your context.
  • Identifying ‘champions’: ‘Champions’ are individuals, usually government officials, who have the ability to directly promote or influence policy. This resource helps define who a ‘champion’ can be, and how their level of support for a cause can be measured to help determine to what degree they will advocate for your cause.

Influencing policy: Individuals in decision-making roles may be influenced to act through different types of information. Some people may find detailed health data or economic information persuasive, whereas other people may be compelled to act based on human stories or personal experiences. Below we outline some ways of sharing advocacy information and influencing decision makers:

  • Policy briefs: Short, clear and detailed letters targeted to decision-makers can be influential in relaying your message. Sanitation and Water for All have created a document with information about COVID-19 and messages targeted to policymakers about the importance of prioritising WASH at this time. However, make sure that policy briefs are followed up by direct engagement with decision-makers as this is more likely to lead to concrete action.
  • Media work: The media can be leveraged in many ways for advocacy and help increase the reach of your message and mobilise support, whether it be through traditional channels, such as newspaper op-eds, the radio and television, or through social media. Utilising media can be a cost-effective means to relay information and present it in various creative ways.
  • Creative use of media: The way you convey information can also make a difference. Consider creative approaches to influencing such as the use of videos, infographics, social media, data visualisation and so on.
  • High-level events: High-level events, such as conferences or other public events may provide an opportunity to advocate to a larger audience or specific stakeholders who are important to your cause. However, consideration should be given to how advocating at high-level events will need to be adapted, or changed to ‘digital advocacy,’ due to COVID-19 and there being fewer opportunities for in-person events and conversations.
  • Policy papers: Findings from academic research may present recommendations for WASH policy changes that are based in evidence (Study 1, Study 2, Study 3) or evaluate government programmes to hold them accountable for their WASH policies (Study 4). Policy papers published during the pandemic can advocate and put pressure on international actors and governments to implement or adapt policies to respond to COVID-19.

Strategic advocacy work: Advocacy work rarely leads to rapid change. Rather change is more likely to occur when you have developed sustained partnerships and when your organization has gained a position of trust among key actors and decision makers. Below we outline some longer term actions that organizations can take to allow them to be more strategic about their advocacy approach.

  • Develop a range of local advocacy champions: Decision makers may be more likely to act when they are under pressure to do so from a range of stakeholders. Organizations can help to build the advocacy skills of a range of local actors so that they can speak with a ‘collective voice’. This could include helping individuals to realize that water, sanitation, hygiene and health are human rights and encourage people to demand these rights from their elected representatives or those that are accountable to them. It could also include supporting civil society organizations (CSOs) who may be better placed to speak on behalf of populations. This blog from IRC provides several examples of how their advocacy work with CSOs was adapted during the pandemic.
  • Develop relationships with media: Journalists working for mainstream media have a huge potential to shape how COVID-19 is perceived by populations and influence whether the pandemic becomes a catalyst for longer-term policy change. It may be worth building relationships with journalists and strengthening their skills so that they are in a better position to report on COVID-19 and associated health and hygiene issues. For example, early on in the pandemic epidemiologists from Canada started online epidemiology courses for journalists in India and Africa. When COVID-19 cases started to appear in Sierra Leone, BBC Media Action were able to build upon their existing partnerships and training experience with media actors and develop a unique online training course for journalists.
  • Build a case for change by aligning your work to national priorities: Achieving policy change over the longer term should be viewed as a political, as well as technical, issue. This means that in addition to having a sound technical argument (ie. related to health, hygiene and wellbeing) organizations also need to align their advocacy work to the political interests of the national government. The way an issue is framed can influence its policy success. For example, the ‘Clean India’ initiative aimed to rapidly scale up sanitation throughout rural India. To do this, toilets were positioned as an economic issue related to the modernizing of India rather than a health issue, and this resulted in a 56% increase in toilets in 5 years. Amid the economic impacts of the COVID-19 pandemic, many countries are facing political change, economic uncertainty, social unrest, or increased tension between social/ethnic groupings. Advocacy efforts need to be constantly mindful of this as these key moments of change can advance or hinder the policy agenda. Moments of change can also change power dynamics meaning that decision-makers or influencers you have spent time building a relationship with are suddenly no longer in charge or influential. Therefore, regular reflection, learning, adaptation is essential and it is important to pay attention to key political events like high-level meetings, strategy formulation processes and political elections.

Additional Resources on Advocacy:

CARE’s advocacy tools and guidelines – Gives a good introduction to what advocacy is, how it is used, and how to create a plan to advocate, along with tips on implementation

Commonwealth Foundation’s advocacy toolkit – A simple, illustrated guide on the advocacy process and strategies for advocacy

Global Handwashing Partnership Hygiene Advocacy toolkit – Provides simple and clear guidance on advocacy specific to hygiene programming and links hygiene promotion to SDGs

IRC webinar and article on adapting advocacy – This resource provides information, with examples from Kenya, Bangladesh, Burkina Faso and Ghana, on how to adapt WASH advocacy strategies in response to COVID-19

Tearfund’s advocacy toolkit – A comprehensive guide that explains the the foundational elements of advocacy, breaks down the process of advocacy and provides case studies, training exercises

UNICEF’s advocacy toolkit – A very extensive document that provides in-depth information on what advocacy is, developing an advocacy strategy, monitoring and evaluating advocacy, managing knowledge and risks, and how to utilise partnerships

UNICEF’s guidance for advocacy in emergency settings – Describes various types of advocacy and gives overview of developing advocacy strategies with consideration of emergency programme contexts

WASH in Health Care Facilities advocacy toolkit – This document provides simple guidance on advocating to various stakeholders for WASH specifically in Health Care Facilities, but can be adapted for other settings

WHO’s guide to advocacy – A step-by-step guide on developing advocacy strategies, specifically for preventing chronic disease, but which can easily be adapted for other initiatives

Editor's note

Author: Elli Leontsini, Peter Winch and Anika Jain
Reviewers: Tracy Morse, Helen Hamilton, Dan Jones, Sian White, Jenala Chipungu
Last update: 04.01.21

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