This module covers the concept of integration, a process by which interventions aimed at handwashing with soap behavior change are incorporated into existing services or programs, such as those attempting to reduce diarrhea, improve nutritional status, or increase rural water supply.  The presentation outlines the four dimensions of integration. The first dimension, points of entry, prompts questions what settings – such as clinics and schools or within other points of delivery for current services – the behavior change intervention should take place. To ensure interventions are taking place in the planned quantity and quality, dimension 2 stresses supervising implementation at the local level. Dimension 3 – management and oversight – covers the need for accountability and transparency in implementation. Dimension 4 is monitoring and evaluation, which tracks the coverage and reach of the intervention, changes in behavioral determinants, and behavior change outcomes.

Key TermsKeep in Mind




  • Know your audience and its needs.
    Before deciding on “what” or “how” to integrate, focus on the country itself and its particular population and geography.
  • Pick your moment.
    Introducing handwashing practice at major life-changing moments—such as marriage or the birth of a first child—makes the effort much more likely to succeed and the handwashing more likely to become a habit.
  • Training alone is not enough.
    Service providers need their responsibilities clearly outlined in job descriptions; they also need supervision and clear incentives.
  • Gather key data at every opportunity.
    Include indicators related to handwashing with soap in your routine data collection and D5periodic surveys.
  • Emergent Learning About Learning
    A challenge for projects implemented at scale and in multiple countries is to capture and disseminate learning in a way that is systematic, timely, and of benefit to country teams, clients, partners, and programmers. Another challenge is to continuously test key assumptions underlying the program design and activities. WSP’s Global Scaling Up Handwashing Project has implemented a culture of learning to help meet these challenges and achieve the project’s learning goals.
  • Synthesis of Four Country Enabling Environment Assessments for Scaling Up Handwashing
    WSP’s Global Scaling Up Handwashing Project conducted enabling environment assessments to strategize project implementation in Peru, Senegal, Tanzania, and Vietnam. Included are findings, preliminary conclusions, lessons learned, and recommendations to strengthen enabling environments. Conclusions encompass the importance of involving local government in the scaling-up process; developing case studies on linkages between handwashing and other programs; striking a balance between mass media and interpersonal communications; and tracking the private sector’s involvement in public-private partnerships.
  • Improving Measures of Handwashing Behavior
    As handwashing promotion is scaled up and adopted by more organizations, the need for field-friendly, affordable, and readily adaptable monitoring and evaluation techniques has increased. A WSP study in Bangladesh set out to determine the most effective methods for measuring handwashing behaviors, with particular interest in the utility of sensor soap. Included are study findings and recommendations for researchers and public health professionals tasked with measuring handwashing behavior.
  • Developing a Decentralized Performance Monitoring System in Senegal
    WSP Senegal developed and used a decentralized monitoring information system (MIS) to monitor performance. The system, which is capable of managing a large volume of data, is influencing ongoing projects by multiple agencies. This database has been recognized as a model by other public sector organizations, such as AGETIP for implementation of the Global Sanitation Fund in Senegal and the Municipality of Dakar.