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How are hygiene programmes designed in crises? A qualitative study of the perspectives of humanitarians in the Democratic Republic of the Congo and Iraq


Hygiene behaviour change programmes are complex to design. These challenges are heightened during
crises when humanitarian responders are under pressure to implement programmes rapidly despite
having limited information about the local situation, behaviours and opinions – all of which may also be
rapidly evolving.


We conducted in-depth interviews with 36 humanitarian staff involved in hygiene programme design in
two crisis-affected settings – one a conflict affected setting (Iraq) and the other amid a cholera outbreak
(DRC). Interviews explored decision-making in each phase of the humanitarian project cycle and were
thematically analysed.


Participants considered the design and implementation of hygiene programmes in crises to be suboptimal. Humanitarians faced sector-specific challenges as well as more general constraints associated
with operating within the humanitarian system. Programme-design decisions were made naturalistically
and relied heavily on the intuitions and assumptions of senior WASH staff. National organisations were
often side-lined from programme design processes despite being in a better position to gather situational
data. Consequently, programme design and decision-making processes adopted by humanitarians were
similar across the two settings studied and led to similar types of hygiene promotion activities being


Hygiene programming in crises-affected settings could be strengthened by initiatives targeted at
supporting humanitarian staff during the pre-implementation programme design phase. This may include
rapid assessment tools to better understand behavioural determinants in crisis-affected contexts; the use
of a theory of change to inform the selection of programme activities; and funding mechanisms which
encourage equitable partnerships, phased programming, regular adaptation and have programmatic
components targeted at sustainability and sector capacity building. Initiatives aimed at sector reform
should be cognisant of inter and intra-organisational dynamics, the ways that expertise is created and
valued by the sector, and humanitarian habits and norms that arise in response to system constraints
and pressures. These micro-organisational processes affect macro-level outcomes related to programme quality and acceptability and determine or limit the roles of national actors in programme design processes.

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