Patty O'Hayer Global Head of Communications & Government Affairs, Reckitt Benckiser
EVERY DAY 1,300 YOUNG CHILDREN DIE OF A TRAGIC, BUT PREVENTABLE ILLNESS
Every day 1,300 children under five die from diarrhoea - a tragically preventable illness. But helping to empower women and encouraging behaviour change remain the key to saving lives.
At Reckitt Benckiser, our purpose is to protect, heal and nurture in the relentless pursuit of a cleaner and healthier world. This approach to health has led us to focus on three areas for our social impact work:
- Nutrition and maternal child health
- Water, hygiene and sanitation
- Sexual health and sexual rights
Good health is underpinned by the foundations of improved hygiene, sanitation and nutrition, all of which form the foundations upon which all healthy lives are based.
In recent years, one of the most significant advances we have made in pursuit of our goals has been our fight to combat diarrhoea as a leading cause of preventable deaths of children under the age of five, causing nearly 1,300 deaths a day.
An issue few were prepared to tackle
How does one measure progress against one of the world’s most devastatingly common illnesses? The answer is simple: ‘Are fewer children dying of diarrhoea?’
This was the focus of a five-year project that not only allowed us to achieve some remarkable progress in the fight to save lives in the developing world, but also provided us with a number of invaluable lessons about how to tackle similarly ‘intractable’ projects in the future.
Our mission was ambitious, and results were often both revealing and unexpected.
We picked an exceptionally difficult problem: diarrhoea, an issue that few seemed to want to tackle. In setting out our approach, we selected three of the countries with the highest incidence and prevalence: India, Pakistan and Nigeria.
We approached our work with one singular, over-riding ambition: “To reduce by 50% the incidence and prevalence of this preventable disease and 30% the mortality and morbidity of diarrhoea.”
Among the first of many lessons we learned was people in the effected regions often do not identify diarrhoea as a condition. Consequently, this made designing
solutions difficult, when it was not widely considered a problem to the local population.
Influencing behaviour indirectly
Perhaps our most significant learning of the entire project was that behaviour is the hardest thing to change.
In India, Prime Minister Modi came to power with the target of ending the practice of open defecation practised by some 600 million Indians. The ambition was set to build 110 million toilets. However, data suggested that nearly 50% of toilets tragically ended up not being used either because they were not maintained or because people did not understand the necessity to use them. The idea of building the toilets and
having people use them, was fundamentally flawed. Investments in infrastructure need to be accompanied by education and behaviour change - only then will the efforts be sustained and effective.
At RB, we have considerable understanding of consumer behaviour: we study consumers and we know what motivates them. This helps us to understand that we have an ability to influence behaviour through indirect means.
In Pakistan, we made a difference through education, but more importantly by driving this education through local rural women, promoting women’s empowerment and employment. An indirect but effective route to solving the problem of reducing the incidence of diarrhoea.
We created a women’s empowerment business model with the UK Department for International Development (DFID) and other local manufacturers to create a consortium which aimed to improve the health and hygiene conditions of rural Pakistan. Today, that newly-founded business is an independent company, which forms the basis of a University of Michigan development case study.
It will be important that we preserve the understanding of hygiene that has resulted from Covid-19.
In the first couple of weeks of lockdown, the general population were washing their hands very regularly, as much as 20 times a day. Yet before the crisis, according to a Unicef study just 17% of the world’s population washed their hands after going to the toilet.
In the UK, that statistic is also of concern, with 32% of men and 64% of women washing their hands after going to the toilet – despite 99% of people telling us they do. Even in hospital, the frequency of handwashing by patients is only 40%.
So, the gap we must overcome is not education, but behaviour change.
We need to understand why people do not wash their hands as often as they should.
Our healthcare workers are among the most educated people in the world, but if they are only washing their hands 40% of the time we need to ask ourselves why that is. Only then will we see true behaviour change!
Unless people remember and understand how much disease is transferred via our hands, then we will fail to make dramatic changes. If we don’t understand the issues,
we can’t fix the problem. I would like to see every country develop health protocols, and make sure we are communicating around the importance of hand and surface hygiene; that we are tracking what our populations are doing, and using our psychologists
and behavioural scientists to shift our behaviour.
So, sometimes the best way to keep ourselves healthy is to do some very simple things.
Going door to door
These women whom we refer to as ‘sehat apas’ or health sisters, sell baskets of health and hygiene products door-to-door across the countryside. With training, these volunteers were also able to circulate advice and good hygiene practices to families as they went about their daily rounds. This approach proved so successful in our single trial that it was expanded from 600 households to 48 villages across the country within a year, with an estimated reduction of yearly deaths from 53,000 to 39,000 reported across the country.
Previously most of the women were not working outside the home and now 24% sehat apas are the primary breadwinners. The unintended consequences of this transformation have led to the creation of extra employment for a large number of sehat apas and will ensure healthier communities for up to one million people in Pakistan.
In India, we also found ourselves differing from the expected approach.
We would hear people say: “If only you made soap cheaper, then more people would wash their hands.” Except, we soon found this to be untrue. Our research showed soap was present in 97% of all households, even amongst the bottom of the pyramid. It was not the presence of soap which was the biggest issue to solve but the frequency - it might only be used once a week.
So, we did what we usually do; we started with some consumer research to understand barriers to usage. Often these women live in houses that are scrupulously clean and they take enormous pride in their appearance. Yet, they told us that what stopped them from washing their hands was that it used a lot of water and they found if they washed their hands regularly, they became dry.
IN THE DEVELOPING WORLD, OFTEN SIMPLY BUILDING A TAP, A PUMP OR A TOILET WON’T SHIFT BEHAVIOUR.
Building a tap, a pump or a toilet won’t change behaviour
So instead of making a cheaper bar of soap, stripping out all unnecessary elements, we innovated by making a bar that was very heavy on perfume, adding lanolin to moisturise. The extra cost was necessary to drive frequency of use and this was essential to addressing our target of breaking the chain of infection. It was only by peeling back the onion, and understanding the problem, that we began to understand what the true barriers were.
In the developing world, often simply building a tap, a pump or a toilet won’t shift behaviour.
In the same way, our own discovery seemed counter-intuitive: a more expensive soap, which allowed women to keep their hands soft, could have a greater effect on handwashing and diarrhoea reduction than a cheaper, more abrasive version.
However, these discoveries also aligned with our understanding that consumers in the lower socio-economic bracket often place a greater emphasis on both brands and aspiration, realising that every little step they take will help them to live better and more prosperous lives.
Perhaps more than any other group, these women are also buying into brands because they are buying into the idea of a better life.
Thinking it over, the work we’ve done, particularly in Pakistan, is likely to be the most enduring. It will continue to drive home hand-hygiene messages because the women carrying those messages from one village to another, also make money from their work.
That is possibly the biggest and most longstanding impact that we could hope to have!
We are setting our sights on our next challenge which is equally, if not even more ambitious, to ensure that every girl in sub-Saharan Africa will have access to sexual health and sexual rights education. A challenge for sure, but one that focuses on women and girls as not only the most effective change agents, but also those most affected by STIs, unwanted pregnancies and HIV – with 75% of all new infections affecting girls 16-24.