(DOH HPB) PA2 Playbook - Behavioral Nudges For Hand Hygiene

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Behavioral Nudges for Hand Hygiene 1

TABLE OF CONTENTS
Introduction 2
Summary of Evidence 3
Implementation Plan 8
Policy 12
Resource Requirements 13
Capacity-Development 15
Communication Plan 17
Monitoring and Evaluation 19
Frequently Asked Questions 22
Case Study 26
Annexes 30
Annex A. Template Policy 31
Annex B. Implementers' Guide to Behavioral Nudges 40
Annex C. Template Nudge Designs and Communication Materials 46
Annex D. Monitoring and Evaluation Reporting Template 48
Annex E. Facility Observation and Spot-Check Template 49
Annex F. Proper Handwashing Observation Forms 52
Annex G. Intercept Survey Form Template 53
4 Community Health Promotion Playbook
Introduction
What is this Health Promotion Program all about?

The Health Promotion Program: Behavioral Nudges for Hand Hygiene introduces nudges
as a low-cost, effective, and easily scalable intervention to lead people toward the intended
behavior of proper hand hygiene and handwashing.
Why implement this Health Promotion Program?
KEY MESSAGES
● Handwashing is one of the most effective ways to curb the transmission of

communicable diseases, including COVID-19.
● Knowledge alone does not change behavior. Even during this pandemic, knowing
that handwashing is one of the best defenses against COVID-19 is not enough to
motivate a behavioral change.
● Well-designed behavioral nudges that promote handwashing are effective,

low-cost, and easily scalable interventions in promoting and sustaining
handwashing behavior.
● Behavioral nudges have a positive influence on increasing access to functional

handwashing facilities as well because these were seen as a nudge to provide
soap in facilities where it was not already available.

Summary of Evidence
Why implement this Health Promotion Program?
The following summarizes the evidence and proof of effectiveness of the proposed Health Promotion
Program which can assist you in lobbying and advocating to decision makers and other target
audiences for the importance of the program.
HAND HYGIENE AND BEHAVIORAL NUDGES
Critical Moments and Enabling Environments for Hand Hygiene
● Handwashing is one of the easiest and most effective defenses against

communicable diseases, including COVID-19.
○ Even before the pandemic, handwashing has been recognized as an effective
measure to reduce the spread of respiratory tract infections, diarrhea, and
other communicable diseases.
● Handwashing with soap has always been recommended at the following critical
occasions:1
○ Before preparing food;
○ Before eating;
○ Before feeding a child;
○ After using the toilet;
○ After changing a baby’s diaper, wiping a child’s bottom or helping a child use
the toilet; and
○ After touching animals and pets.
● However, due to COVID-19, additional critical occasions for handwashing with
soap now include:
○ After coughing or sneezing;
○ When entering or leaving the household or any other building;
○ After coming into physical contact with anyone outside your household;
○ After touching surfaces when outside the home (e.g. door knobs, railing,
money etc.);
○ After visiting a public space, including public transportation, markets and
places of worship; and
○ Before, during and after caring for a sick person.
● 93% OF HOUSEHOLDS HAVE A PLACE FOR HANDWASHING; OF THESE, 89%
HAD SOAP AND WATER AND ONLY 3% HAD NO SOAP, WATER, OR CLEANING
AGENTS. 2 Despite these, sustained improvement to handwashing behavior is still a
public health concern.

Behavioral Nudges to Address Handwashing Determinants
● Physical, social, or cognitive factors may determine and influence behaviors like
handwashing.3 This is why even with education, policy, and infrastructure in place,
handwashing can still be forgotten.
○ These determinants should be considered in order to effectively overcome
behavioral barriers.
● Behavioral nudges may be a good policy option when the desired behavior is not
restricted by a lack of knowledge or poor enabling conditions like a lack of functional
facilities.
○ Nudges function as indirect suggestions to influence behavior and decision
making.
○ While they are not enough to change and sustain handwashing behavior on
their own, they are EFFECTIVE WHEN USED AS A COMPLEMENT TO
OTHER MORE COMPREHENSIVE APPROACHES AND MULTIMODAL
STRATEGIES, such as ensuring the availability of functioning hand hygiene
facilities.
What are Nudges?4
Nudges are defined as “choice architecture that alters people’s behavior in a

predictable way without forbidding any options.” The idea of nudges is based on the
theory that behavior is not only based on conscious thoughts and decisions, but that
choice architecture can unconsciously guide it. Nudges do not rely on changing a person’s
rational decision making, nor do they forbid a behavior or directly change incentives.
Rather, nudges are a strategic intervention that places emphasis on choice design.5
There are two main types of behavioral nudges:6

1. Contextual cues: changes to the environment where a behavior is practiced to make
the behavior more likely. These are theorized to trigger responses to particular kinds
of stimuli which can lead to habit formation. (e.g. painted arrows or footprints
leading to handwashing station or facility)
2. Visual reminders: signs to trigger conscious motivators for practicing the behavior
(e.g. posters with germs on hands to evoke sense of disgust)

USE OF BEHAVIORAL NUDGES IN VARIOUS SETTINGS
DepEd WASH in Schools (WinS) Policy and

Behavioral Nudges7
● The Department of Education (DepEd) has

sought to increase handwashing among
schoolchildren with their WinS policy.
● A study tested low-cost, behavioral nudges
as a new approach to WinS. It adapted
designs from previous studies to the local
context in Zamboanga del Norte schools and
added new nudges based on field visits to
school sites. These included:
○ Footpaths with painted footprints
from toilets to handwashing area
○ Posters with simple visual
handwashing messages in toilet stall
○ “Watching eye” sticker above the
faucet or water source
○ Arrow sticker pointing to a soap dish by the handwashing area
● The study saw promising findings and an overall increase in behaviors related to
proper handwashing across the 49 treatment group schools with nudges installed.
○ Compared to control group schools, handwashing rates increased among
students BY 17.3 PERCENTAGE POINTS OR 148 PERCENT, EVEN FOUR
MONTHS AFTER INITIAL IMPLEMENTATION, which points towards the
intervention sustaining proper handwashing behaviors.
○ Treatment schools were 38% MORE LIKELY TO HAVE ACCESS TO
FUNCTIONAL HANDWASHING FACILITIES WITH SOAP because the
program was also able to nudge teachers to provide soap in classrooms and
facilities where it was not already available.
Behavioral Nudges in Workplaces and Hospitals
● Hospital visitor use of hand sanitizer INCREASED FROM 7% IN THE CONTROL TO

46% when an eye-catching sign is placed to emphasize that hand sanitizer use is the
norm (“Here we use HAND DISINFECTANT”).8
● A Real-Time Voice Reminder which reminds hospital workers to “Please sanitize!”
MORE THAN DOUBLES hand hygiene performance on average. When turned off,
within six weeks, hand hygiene drops back to baseline levels but returns to previous
levels within six weeks of being turned back on.9

The Department of Health promotes the use of behavioral nudges to encourage proper
hand hygiene and combat the spread of COVID-19 and other communicable diseases.
● Increase the availability and accessibility of handwashing facilities and/or sanitation

stations in public spaces and other priority settings
● Improve the state of existing handwashing facilities and/or sanitation stations and
ensure proper maintenance and provision of sufficient necessary supplies
● Install handwashing behavioral nudges in handwashing facilities and sanitation
stations accessible to the public
● Develop strategies complementary to behavioral nudges in order to further
encourage and sustain proper hand hygiene behavior

Implementation Plan
How do we ensure effective implementation of this

Health Promotion Program?
The following checklist provides steps (not necessarily in chronological order) on implementing the
recommended Health Promotion Program with corresponding recommendatory persons/offices
responsible per step. The local government’s Health Promotion Unit must coordinate with various
stakeholders to ensure effective implementation of the Health Promotion Program.
For an editable version of this plan, please visit: https://tinyurl.com/PA2Playbook-ImplementationPlan
Office/Person Target
Activity
Responsible Date
1. Engage with stakeholders, target audiences, and local implementers
☐ Convene relevant stakeholders on health promotion, the

HPFS, and the Playbook, specifically but not limited to
the following:
● Local Health Board
● Local implementers
● Representatives of relevant government
agencies (DepEd, DILG)
● Local businesses/ establishments related to
identified settings
● Vulnerable or marginalized sectors (women, Health
youth, elderly, PWDs) Promotion
● Local people’s organizations
Unit
● Schools
☐ Develop a Work and Financial Plan based on a

Behavioral Nudge Master Plan co-created with
identified relevant stakeholders and local implementers
(See Resource Requirements Section for necessary
procurements)
☐ Explore partnerships for the different activities involved

in implementing nudge-based interventions
2. Create a Behavioral Nudge Master Plan customized to fit the needs and

contexts of the localities where intervention will be implemented
☐ Select priority settings - public spaces, business

Health
establishments, schools, health centers, etc. - and map
Promotion
out strategic areas where behavioral nudges can be
installed. These areas may already have existing
Unit

handwashing facilities and sanitation stations or may
need installation of facilities
☐ For areas with existing facilities: Ensure that selected

handwashing facilities and sanitation stations are
functional and well-maintained, accessible, and
properly supplied with water and soap
For areas where facilities need to be installed: Take into

consideration access to water supply, space availability
(such that the facility will not cause obstruction), foot
traffic in the area, and long-term operation and
maintenance of the facility, including provision of water
and soap
☐ Identify appropriate behavioral nudges to be installed in

chosen settings/areas and develop technical and design
specifications for each type of nudge (See Annex B for
recommended application and settings)
Health
☐ Optional: Design customized nudges (See Annex C for
Promotion
ready-to-use/ printable materials provided in this
Playbook; designs may be modified as long as they
Unit
follow the same concepts)
Optional: Conduct pilot test for customized nudges in an

easily observable and controlled environment (office,
school, or health center)
☐ Develop a communication plan and identify community

engagement activities which can be conducted in
support of the intervention (See Communication Plan
section for proposed Communications Package provided
in this Playbook)
☐ Develop a monitoring and evaluation system for routine

inspection, maintenance, and evaluation of installed
behavioral nudges (See Annexes D-G for proposed
M&E Plan and tools provided in this Playbook)
3. Develop and facilitate the passage of a local policy to institutionalize the

nudge intervention
☐ Refer to the Playbook’s attached template policy

(Annex A) and revise it accordingly to reflect local
plans, delineation of roles and responsibilities of Health
Province and City/Municipal Health Offices and other
Promotion
implementers, etc.
Unit
☐ Identify and tap champion/s in the local government and
the community to lobby for the approval and signing of

a Local Board Resolution and the passage and
enactment of the policy
4. Prepare logistical and resource needs for the implementation of the

intervention and related activities
☐ Identify local budget items and prepare costing for

behavioral nudge materials to be produced and other
related activities to be conducted (Refer to Resource
Requirements Section) Health
Promotion
☐ Prepare and process all necessary documentary Unit
requirements (e.g., signed purchase request, purchase
order, inspection and acceptance report, requisition and
issue slip, budget utilization report, etc.)
5. Conduct capacity building activities for identified local implementers
☐ Identify local implementers from the Provincial and

City/Municipal Health Offices (e.g., C/MHOs, HEPOs,
Sanitary Engineers & Inspectors, Public Health Nurses,
etc.) to be trained for effective development and
implementation of behavioral nudge intervention
☐ Train identified implementers using modules available

on DOH Academy (follows proposed Capacity Building
Section in this Playbook) or from other training Health
providers Promotion
Unit
☐ Conduct pre- and post-tests for all training participants
and ask them to accomplish module/course evaluations
☐ Optional: Identify other competency gaps (knowledge,

attitude, skills) of implementers for which training is
needed (may be based on results of post-test and
evaluations/feedback). Identify and tap individuals or
groups who can provide training and resources
6. Implement the Behavioral Nudge Master Plan
☐ Install behavioral nudges in identified settings with Local

handwashing facilities and/or sanitation stations implementers
☐ Implement communication plan, employ communication

materials, and conduct community engagement/building
activities (e.g., inauguration of facilities with nudges;
Health
airing of videos, jingles or public service
Promotion
announcements; posting out-of-home reminders in key
locations; deploying caravans, bandilyos, motorcades,
Unit
etc.)

☐ Monitor implementation of the behavioral nudges in
Local
identified settings/areas by collecting and consolidating
implementers
data on suggested indicators (See Annexes D-G)
☐ Analyze monitoring and evaluation results to determine

necessary next steps, such as adjusting/modifying
existing set of nudges, redesigning, or installing a new
set of nudges, and frequency of such actions
☐ Discuss monitoring and evaluation (See Monitoring and

Evaluation Section) results with local implementers Health
and communicate these to the Local Health Board and Promotion
stakeholders for any necessary adjustment of the Unit
Behavioral Nudge Master Plan
☐ Accomplish necessary progress reports and

documentation of the intervention and related activities
(e.g., attendance sheets, client satisfaction surveys,
narrative reports, etc.)
7. Auxiliary Programs, Projects, and Activities (Optional)
☐ Develop multimodal strategies to further encourage and

sustain proper hand hygiene behavior (e.g., distribution
of hygiene kits, integration of sanitation and hygiene
norms into school/workplace policies, or capacity
building for effective teaching and health promotion)
Health
☐ Develop incentive mechanisms for private entities,
Promotion
business establishments, and other commercial facilities
to ensure availability of hand hygiene infrastructure and
Unit
supplies, to install behavioral nudges, or to implement
other innovative hand hygiene measures
☐ Undertake research to identify key determinants of hand

hygiene behavior for specific local contexts and settings

Policy
What is the Policy Support for this Health Promotion Program?

To ensure sustainability and availability of resources to implement Health Promotion programs, it is
recommended that they be institutionalized through local policies such as ordinances. The Playbook
includes a template policy (See Annex A) that local governments may adopt in whole or in part, as
commitment to their efforts to make the healthy choice the easy choice for every Filipino.
AN ORDINANCE ENACTING THE INSTALLATION OF BEHAVIORAL NUDGES IN

PRIORITY SETTINGS
The proposed local ordinance that the Province, City, or Municipality

may adopt and enforce in support of the intervention for behavioral
nudges outlines the rationale and objectives which determine the
priorities and direction of all activities relevant to the policy, as well
as provisions for the terms of implementation, allocation of
resources, and designation of offices/individuals for enforcement.
The following are some key provisions of this template policy:

● Establishment of functioning, accessible, and
well-maintained handwashing facilities with soap and water
and/or sanitation stations with alcohol-based hand rub
dispensers within priority settings and other public spaces
identified by the Province, City, or Municipality
Key Terms and
● Development and installation of different types of
Provisions of the
behavioral nudges led by the Provincial/City/Municipal
Policy
Health Office
● Behavioral nudges suitable for identified priority settings
developed through engagement and consultation with
target audiences and other relevant stakeholders
● Regular monitoring and evaluation of behavioral nudge
installation for reporting to the Local Health Board and
determination of appropriate action, including frequency of
modification and redesigning of nudges
The passage of the aforementioned Ordinance will be useful in

ensuring the availability of human and financial resources for
efforts related to the Behavioral Nudges for Handwashing
Program.

Resource Requirements
What will we need in implementing this Health Promotion Program?

You may use this as a guide for your budget proposal and work and financial planning.
Item
Description Object Class
No.
1 Waterproof sticker paper

A4, 3x4.5 in | matte/ glossy
2 Board paper
A4 | 250-300 gsm
3 Photo paper Office Supplies Expenses

A4 | glossy
4 Laminating film
A4 | 125 microns
5 Ink cartridges
Semi-Expendable - Printing
6 Printer
Equipment
7 Vinyl / tarpaulin
24x46 in
Vellum board Printing and Publication

8
18x27 in | 210-300 gsm | glossy Expenses
9 Cardboard / acrylic sheet

5.85x8.25 in
10 Oil-based paint
11 Paintbrush, paint roller
12 Cement
Other Supplies and Materials
13 Liquid / bar soap Expenses
14 Soap dish / dispenser Other Maintenance and

Operating Expenses
15 Tissue / paper towel
16 Tissue holder / paper towel dispenser
17 Bathroom mirror

Semi-expendable - Other
Machinery and Equipment
18 Hand dryer
Electricity Expenses
Labor
19 (If painting, cementing works needed or for pre-fabrication of WASH Other Professional Services
O’Clock handwashing kiosk)
WASH O’Clock Handwashing Kiosk

● ¾ Marine plywood (semi-gloss white finish)
Other Supplies and Materials
● Plain sheet gauge 20 Expenses
● Gooseneck faucet (stainless/chrome)
● Foot pedal mechanism set (stainless/chrome) Water Expenses
● Flexible hose
20
● Stainless steel sink (15x18 in)
● Vinyl tiles (12x12 in) Other Professional Services
● Wall-mounted soap dispenser
● ½ Flexible drain hose Other Maintenance and
● ½ PVC pipe Operating Expenses
● Versa board (32x78 in)
21 Training logistics Training Expenses

(venue, meals, and other training collaterals)
22 Logistics for regular meetings Representation Expenses

(venue, meals, transportation)
MOA or MOU processing costs

23 (Only applicable If the LGU is receiving grants from national or Accountable Forms Expenses
regional government, or from other entities)

Capacity Development
What do implementers need to learn to successfully implement this

Health Promotion Program?
Courses related to Playbook module implementation are uploaded on DOH Academy
(learn.doh.gov.ph) for accessible use by the general public.
CAPACITY BUILDING FOR IMPLEMENTERS OF BEHAVIORAL NUDGES FOR HAND

HYGIENE
DOH Health Promotion Bureau with UNICEF/Propel-Organic

Course Author
Intelligence, Maynilad, and Maynilad Water Academy
This course was developed to complement the Local Health

System Health Promotion Playbook for Environmental Health -
Behavioral Nudges for Hand Hygiene. It aims to provide
implementers and stakeholders of the behavioral nudge
intervention and other related activities with basic knowledge and
Course Description
technical skills necessary to adequately perform their respective
roles. This course will not only help them better understand the
importance of sanitation and hygiene, but more importantly, also
enable them to plan and implement health promotion initiatives
that encourage and sustain hand hygiene in their communities.
By the end of the course, participants involved in the planning and

implementation of the behavioral nudge intervention should be
able to:
1. Understand the importance of proper sanitation and hand
hygiene in infection prevention and control in various
settings;
2. Understand and apply the fundamentals of social and
behavior change communication (SBCC) and
Learning Outcomes behavior-centered design in planning for behavioral nudges
in public spaces; and
3. Develop communication and relationship-building skills for
community engagement and demand generation for
healthy choices and behaviors; and
4. Produce an action plan (LGU Behavioral Nudge Master
Plan) to guide their implementation and monitoring of the
behavioral nudge intervention and other complementary
programs and strategies.

Module 1: Water, Sanitation, and Hygiene (WASH) in the
Community
1. Empowering Communities through Water, Sanitation, and
Hygiene
2. Strategies for Stronger Engagement in WASH Education
Activities
3. Creative Strategies and Utilizing the Arts for WASH
Engagement
Module 2: Social and Behavior Change Communication (SBCC)

Capacity-Building
for Hand Hygiene
Outline
1. Introduction to Social and Behavior Change Communication
2. The P-Process Framework
3. Strategic Communication Process
4. Behavior Centered Design and Behavioral Nudges
5. Communication Research
Module 3: Strengthening Communication and Presentation

Skills for Hand Hygiene Champions
1. Communication Tools and Rapport Building
2. Non-verbal Indicators and Presentations
Local implementers, including the Health Promotion Unit,

City/Municipal Health Officers, Health Education and Promotion
Expected Audience
Officers, Sanitary Engineers and Inspectors, and other public
health workers
Expected Duration 9 hours

Communication Plan
How do we communicate this Health Promotion Program

to our community?
This section provides suggested key messages and corresponding template communication
materials to support the social mobilization and community engagement activities of the LGU to
increase demand among target audiences for the health promotion program.
Installing behavioral nudges alone may not be enough to change and sustain proper hand
hygiene behaviors. The intervention is more likely to be effective when used alongside other
strategies, such as communication campaigns and advocacy efforts. The following are
communication campaigns that local implementers may integrate with behavioral nudges
and modify according to different contexts and settings in which they are applied.
BIDA SOLUSYON PLUS SA COVID-19
BIDA Solusyon sa COVID-19 (see link: http://bit.ly/BIDAPlus) is a campaign that carries

the key message that every Filipino is part of the solution to win the global fight against the
pandemic. This is represented by the main campaign logo, which shows that taking simple
steps and precautionary measures enables everyone to “BIDA Solusyon”. Explained in
simple, easy-to-understand terms that highlight the importance of actions, the campaign
aims to uplift spirits and give people confidence in knowing that their simple actions help
make a difference in their community and their country.
Moreover, the campaign shows that as the world continues to develop long-term solutions,
and as the government and health workers continue to safeguard people from the disease,
we should not let our guard down. New evidence points to interventions that can augment
our existing BIDA Steps. These actions can be simplified into the following acronym:
B Bawal walang mask at face shield

I I-sanitize ang kamay at iwasan ang kulob na lugar
D Dumistansya ng isang metro at limitahan ang pisikal na interaksyon sa iba
A Alamin ang tamang impormasyon
Plus Suportahan ang FDA approved na bakuna
The BIDA Solusyon sa COVID-19 campaign contains various materials (see Annex C) which
may be used as behavioral nudges (i.e. simple handwashing reminders and messages).
Alternatively, directional designs, handprints, germ stickers, and other nudge types may be
used to further reinforce the “I-sanitize ang kamay at iwasan ang kulob na lugar''
component and messaging which encourages proper hand hygiene alongside good air
ventilation.

WASH O’CLOCK CAMPAIGN
The WASH O’Clock campaign uses behavioral nudges to encourage proper handwashing
during critical moments, and as people go about their daily lives in various community
settings. The nudges used are in the form of visual reminders written in signages that can
be posted in key public areas and public utility vehicles. The campaign also includes
installation of facilities in frequently visited public areas such as transit hubs, markets,
government offices, health centers, churches, malls and restaurants. Ready-to-print
materials can be downloaded (see Annex C) and editable files can be requested from
ghdpilipinas@gmail.com.
KEY MESSAGE: PRACTICE PROPER HANDWASHING WITH SOAP AND WATER

DURING CRITICAL MOMENTS
Materials (see Annex C):

1. Signages for Public Utility Vehicles
a. Ipasa ang Bayad, ‘Wag ang Germs
b. Sakay. Bayad. Baba. Hugas
2. Poster, Stickers, or Vinyls/Tarpaulins
a. Pagkagamit ng Toilet
b. Bago Kumain
c. Pagkatapos Bumiyahe
d. Idaan sa Dasal at Paghugas ng Kamay
e. Namalengke Ka Mars?
f. Sabi Ni Doc
3. Jingles
a. For Parents
b. For Workforce
Suggested Activities:
1. Conduct official inauguration of handwashing facilities and installed nudges to
showcase the LGU’s initiative
2. Develop and air videos, jingles, or public services announcements on television or
radio stations
3. Post out-of-home reminders (e.g., tarpaulins, posters, etc.) in key locations and
means of transportation
4. Generate engagement and participation of target audiences through social media
channels and posts
5. Conduct community activities such as roving caravans, bandilyos, motorcades

Monitoring and Evaluation
How do we keep track of our progress?
Summary of Indicators
Outputs:
● Number of existing and new handwashing facilities and sanitation stations in
identified priority settings/areas
● Number of bar soaps or volume of liquid soap used in identified handwashing
facilities
● Water meter reading (if dedicated meter installed)
Outcomes:
● Usage rate of handwashing facilities and sanitation stations with behavioral nudges
installed (actual vs. potential users)
● Number of users observed practicing proper handwashing steps
● Incidence of infectious diseases related to hand hygiene - e.g., COVID-19, diarrhea,
other gastrointestinal and respiratory illnesses (Percentage decrease)
Monitoring Intended
Indicators Description
Form User
All indicators listed Monitoring and This reporting form can be Provincial/
above Evaluation used to summarize baseline City/
Reporting data, targets, and Municipal
Template achievements for each Health Office
(see Annex D) proposed indicator and other
indicators deemed by
implementers as necessary for
evaluation of this health
promotion program.
Usage rate of Facility This is designed as a log or Local

handwashing facilities Observation checklist which incorporates a Monitoring
and sanitation stations and Spot Check structured direct observation Officer/s (as
with behavioral nudges Template and a spot-check for designated
installed (actual vs. (see Annex E) handwashing facilities and by Health
potential users) sanitation stations and which Office)
shall be used once

Number of bar soaps or infrastructure and supplies are
volume of liquid soap in place and functional.
used in identified
handwashing facilities The first part is a tally of
potential users of the facilities
Water meter reading (if versus the actual number of
dedicated meter people who properly wash or
installed) sanitize their hands within a
two (2) hour observation
period. The second is a
checklist for monitoring the
maintenance and availability
of the infrastructure and
supplies. Behavioral nudges
are enumerated per type to
allow each one’s lifespan or
issues with installation to be
reflected. Officer/s shall also
note other details and
observations related to usage
and replacement or
reinstallation of any of the
components.
Usage rate of Proper This form is designed for the Local

handwashing facilities Handwashing observation of handwashing Monitoring
and sanitation stations Observation facility users and whether Officer/s (as
with behavioral nudges Form they practice all the steps of designated
installed (actual vs. (see Annex F) proper handwashing. It can be by Health
potential users) used together with the above Office)
checklist during the 2 hour
Number of users observation period.
observed practicing
proper handwashing This was used for WASH
steps O’Clock campaign monitoring
but can be adopted by the
LGU and limited to fewer
steps to make observation of
handwashing behaviors
easier.
Feedback of Users of Intercept The intercept survey is Target

Handwashing Facilities Survey Form designed to gather feedback Audience/
on Behavioral Nudges (see Annex G) from users of handwashing Beneficiaries,
facilities on their experiences as
in interacting with the administered

behavioral nudges. This was by Local
used for WASH O’Clock Monitoring
campaign monitoring and as Officer/s
such, has specific questions
for it, but the survey can be
adjusted to reflect different
types of nudges used by the
LGU.
Every 3 to 5 persons who

pass by the coverage area can
be invited to participate in the
intercept survey, but only
those between 18-50 years
old and have a household
income of Php50,000 and
below or those with blue
collar jobs will be selected to
make sure that the campaign
is relevant to them. It is
recommended to conduct the
survey during times with high
foot traffic (e.g., early morning
weekends for public markets)
and to gather a sample size of
at least 50 respondents.
General knowledge, Health Literacy The HLA-KAP is an annual Health

attitude and practice of Assessment assessment tool which Promotion
hand hygiene and Knowledge, measures the health literacy Unit
Attitudes and levels of Filipinos aged 18 and
Practice on above in the LGU
Health
Promotion
(HLA-KAP)
Survey

Frequently Asked Questions
FOR LOCAL IMPLEMENTERS
Why should we implement behavioral nudges to encourage proper hand hygiene?

Traditional handwashing promotion approaches focus on education-based messages that
teach people about the importance of handwashing with soap and proper handwashing
technique. However, knowledge is just one of the many possible factors that determine
handwashing behavior. In fact, evidence shows that perceived health benefits and
knowledge are not strong determinants of handwashing behavior change.
Therefore, behavioral nudges may be a good policy option when the desired behavior is not
facilities. Nudges function as indirect suggestions to influence behavior and decision
making, and within the context of the COVID-19 pandemic, it is necessary to enable and
encourage handwashing with soap at critical moments through interventions like this.
Installing behavioral nudges to aid in this purpose and to serve as a complementary
initiative to more comprehensive approaches and multimodal strategies for sustained hand
hygiene behavior change is therefore ideal.
What are the guidelines for designing and installing behavioral nudges?
In planning this intervention, strategies which include observation, engagement with
identified target audiences, or design and pilot testing, shall be utilized in order to develop
behavioral nudges suitable for different public settings and ready to be widely rolled out.
The following aspects and principles shall be considered to ensure the suitability and
effectiveness of the nudges to be designed and implemented:
a. Behavior-Centered Design. Interventions meant to change behavior, such as

nudges, must have an approach that is surprising to target audiences, causes a
re-evaluation of the desired handwashing behavior, and ensures that it is more likely
to win out as the best behavioral choice when the next opportunity arises.
b. EAST Principles. Nudges must be easy, attractive, social, and timely. Behavioral
nudges shall be devised with simple and clearly understandable messaging, eye
catching and attractive colors and designs, and a social dimension to reinforce
handwashing behavior as a norm. These shall also be positioned in areas where
target audiences are more receptive to the nudge, such as outside toilet cubicles or
at entrances of dining areas.

c. Resources and Environment. Costs of installing and maintaining the different
nudges and cues shall be considered in the selection and development of
interventions. Affordability, availability, and feasibility of producing the materials
locally shall also be taken into account, as well as the conduciveness of specific
environments in which the nudges are to be installed.
d. Inclusivity. Nudges must also be inclusive and consider how all target audiences in
the different settings and spaces will be able to interact with these. Similar to
handwashing facilities and sanitation stations, nudges installed in these areas must
be free from obstructions and shall appropriately cater to age, gender, or disability
of users.
Where should behavioral nudges be implemented?

These may be implemented in schools, workplaces, marketplaces, and other strategic
public spaces. Nudges can trigger behavior but only if the right tools (e.g., enabling
products and hardware) are in place to enable it; thus, for the intervention to be viable,
there must be handwashing facilities and sufficient soap and water available.
What should be done if there is no handwashing facility in an identified priority area?

Nudges may only be implemented if there is a functional handwashing facility and sufficient
soap and water available. In the case where hand hygiene infrastructure and supplies are
unavailable, implementers may explore installation of interim hand hygiene facilities, such
as handwashing stations or kiosks and hand sanitizer or alcohol dispenser stations.
How will the implementation of behavioral nudges be funded?

Based on the proposed template ordinance in this playbook, the Provincial/City/Municipal
Health Office shall prepare the costing of resource requirements for the implementation of
the behavioral nudge intervention and other related or complementary activities and
include this in its Work and Financial Plan for funding to be earmarked annually. The
funding necessary may be sourced from the following:
1. LGU’s annual Internal Revenue Allotment (IRA);
2. National Government Agency (NGA) subsidy to related programs, projects, and
activities through the relevant agencies; and
3. Supplemental funding requests from relevant NGAs.
Who is in charge of implementing behavioral nudges in the LGU?

Based on the proposed template ordinance in this playbook, the Provincial/City/Municipal
Health Office shall act as the principal implementer of the program. The same shall lead
the development and installation of behavioral nudges in priority settings, but may assign
other individuals or offices to take on other responsibilities related to the intervention.
How often should behavioral nudges be redesigned and replaced?

Nudges will require maintenance, repair, or reinstallation, and the frequency of which shall
depend on the type of nudge used. A local monitoring system which considers the
estimated life of the nudges, estimated cost of maintenance and repair, and availability of
resources for such shall be implemented. Based on this system, the designated person/s or
office shall routinely inspect and assess if installed behavioral nudges are in need of

maintenance, repair, or reinstallation. Maintenance works include, but are not limited to,
cleaning, repainting, and refilling paper towels, soap, or hand rub dispensers.
What other related programs and activities can the LGUs do to promote proper
sanitation and hygiene?
In support of the installation of behavioral nudges in priority settings, implementers may
also develop strategies to further encourage and sustain proper hand hygiene behavior,
such as, but not limited to:
1. Promoting proper sanitation and hand hygiene among households, office workers,
and students by investing in and strategically distributing free hygiene kits;
2. Exploring incentive mechanisms to encourage private entities, business
establishments, and other commercial facilities to ensure availability of hand
hygiene infrastructure and supplies, to install behavioral nudges, and to implement
other innovative hand hygiene measures;
3. Undertaking research to identify key determinants of hand hygiene behavior for
specific local contexts and settings in order to develop interventions complementary
to nudges, such as awareness campaigns, practical demonstrations, or using role
models to promote hand hygiene;
4. Integrating proper sanitation and hygiene norms into school or workplace policies;
5. Conducting capacity building activities to enable faculty/staff/employees to
effectively teach and promote proper sanitation and hygiene;
6. Promoting proper and regular handwashing practice through a communication
strategy which includes disseminating materials in local television and radio
stations, print media, and social media channels and conducting community
activities such as caravans or bandilyos to play jingles reminding people to wash
their hands with soap and water.
FOR OTHER STAKEHOLDERS (I.E., PRIVATE SECTOR)
Should private establishments and businesses implement behavioral nudges?

Based on the proposed ordinance, in support of the installation of behavioral nudges in
priority settings, implementers may develop incentive mechanisms to encourage private
entities, business establishments, and other commercial facilities to implement behavioral
nudge interventions. They may explore requiring the installation of nudges in handwashing
facilities and sanitation stations, as a regulatory requirement prior to the reopening of
schools, operation of establishments, or renewal or issuance of local Sanitary and/or
Business Permit/s to offices, establishments, and buildings.
Do behavioral nudges provide any benefit for private establishments and businesses?
Implementation of behavioral nudges provides an enabling environment for the general
public to practice proper hand hygiene. The visible presence of these efforts will boost the
customers’ sense of security, ease the process of sustaining desired hand hygiene behavior,
and generally improve public trust in the establishments.

FOR THE GENERAL PUBLIC
What are behavioral nudges?

Nudges are defined as “choice architecture that alters people’s behavior in a predictable
way without forbidding any options.” The idea of nudges is based on the theory that
behavior is not only based on conscious thoughts and decisions, but that choice architecture
can unconsciously guide it. Nudges function as indirect suggestions to influence behavior
and decision making.
Why should we implement behavioral nudges to encourage proper hand hygiene?

Traditional handwashing promotion approaches focus on education-based messages that
teach people about the importance of handwashing with soap and proper handwashing
technique. However, knowledge is just one of the many possible factors that determine
handwashing behavior. In fact, evidence shows that perceived health benefits and
knowledge are not strong determinants of handwashing behavior change.
Therefore, behavioral nudges may be a good policy option when the desired behavior is not
facilities. Nudges function as indirect suggestions to influence behavior and decision
making, and within the context of the COVID-19 pandemic, it is necessary to enable and
encourage handwashing with soap at critical moments through interventions like this.
Installing behavioral nudges to aid in this purpose and to serve as a complementary
initiative to more comprehensive approaches and multimodal strategies for sustained hand
hygiene behavior change is therefore ideal.

Case Study

As part of its thrust to continually improve and streamline efforts in developing and
implementing Health Promotion programs in the communities, the Health Promotion
Bureau piloted the Behavioral Nudges for Hand Hygiene Playbook in Biliran in the year
2021
Demographics
Region Eastern Visayas
Area 555.42 sq km
Total Population 179,312
Municipalities 8
Income classification 4th class
The Province of Biliran, a 4th class island province

in the Eastern Visayas region, is one of the
country’s smallest and newest provinces. Across 8
municipalities and 132 barangays, Biliran has an
estimated population above 179,000.
Problem
By mid-March 2022, the Province was already
able to significantly decrease its number of active COVID-19 cases; however, even with this
decrease, COVID-19 was still considered a serious threat which could hinder the
community’s transition into a new normal. Aside from this, Acute Gastroenteritis remained
to be the second most common cause of morbidity in the Biliran Provincial Hospital despite
achieving 105% of the target number of households to have access to basic safe water
supply. As such, the Local Government, together with the Provincial Health Office, has
identified and encouraged proper hand hygiene as one of the key mitigation strategies to
effectively safeguard public health in the Province.
Assistance Provided
In 2021, the HPB provided Biliran with financial support in the form of a Php 1.44 million
sub-allotment grant, as well as technical assistance such as orientation workshops,

capacity development sessions, and
partnership building opportunities. The
Bureau visited Biliran in 2022 to monitor its
pilot implementation of the Playbook via site
observations, documents reviews, focus
group discussions, and interviews with local
implementers.
Challenges
Delays caused by the COVID-19 pandemic.
The pilot implementation was conducted throughout the height of the COVID-19 pandemic,
which limited what the local implementers could do and posed many difficulties and delays
in their processes. For one, the approval and signing of the MOA between the LGU and
DOH-CHD was delayed, and as a result, the sub-alloted financial grant could not be
downloaded and used for procurement and other Playbook activities until the last quarter
of 2021. Scheduling of capacity building sessions and ensuring that intended participants
would attend was also challenging since the target audience for these were health workers
who were taking on multiple roles and were heavily preoccupied with responsibilities
related to COVID-19 response. Changes in community quarantine status and restrictions
also had to be considered for the conduct of these sessions and other suggested
community engagements.
Lack of human resources and

engagement with other relevant
stakeholders. There is a clear lack of
human resources in the Provincial Health
Office, as well as in the local health units -
particularly those designated for work on
environmental health and sanitation who
were assigned to implement and monitor
the behavioral nudge intervention in their
localities. There is only one Rural Sanitary
Inspector (RSI) in each of Biliran’s
municipalities (except in the capital of
Naval) who, aside from conducting
inspections related to compliance to the
Sanitation Code, are also, among others,
expected to assist in COVID-19 vaccination
efforts and perform the functions of a local
implementer and monitoring officer for the
Playbook as well. They have repeatedly expressed that their work cannot be sustained
without proper institutional support and/or better incentives and that implementation of
behavioral nudges may fall through. There needs to be more engagement with relevant
non-health sector stakeholders, civil society organizations, and other partners to try to
address these issues and augment the capacity of the PHO and RSIs.

Best Practices
Strong commitment and buy in from all municipalities. All 8 municipalities of Biliran
expressed their commitment to the implementation of the behavioral nudge intervention
and volunteered at least 2 handwashing facilities in each of their areas for installation of
the nudges. In addition to these, 1 more site per municipality - in either health centers,
public markets, or transport hubs - was identified for installation of a new WASH O’Clock
handwashing kiosk and more nudges related to the campaign.
Local implementers and monitoring officers capacitated. Despite challenges in scheduling

and attendance, the Provincial Health Office was able to capacitate 24 local implementers
and designated monitoring officers - consisting of Municipal Health Officers, Rural Sanitary
Inspectors, and Public Health Nurses - from the different municipalities. These were
conducted across 3 online and offline/face-to-face sessions and covered all topics in the
Capacity Building Outline of the Playbook

Annexes

Annex A. Template Policy
For an editable version, please visit: https://tinyurl.com/PA2Playbook-TemplatePolicy
[Number] Session
EXCERPT FROM THE MINUTES OF THE REGULAR SESSION OF THE [NUMBER] SANGGUNIANG
[UNIT] OF THE [LGU] HELD AT [LOCATION] ON [DATE]
Present:
[Name] [Position]
[Name] [Position]
[Name] [Position]
On official business:
[Name] [Position]
[Name] [Position]
[Name] [Position]
Absent:
[Name] [Position]
[Name] [Position]
[Name] [Position]
WHEREAS, on 8 March 2020, President Rodrigo Roa Duterte declared a State of Public Health
Emergency throughout the country due to COVID-19, and enjoined all government agencies and
local government units (LGUs) to render full assistance and cooperation and mobilize the necessary
resources to undertake critical, urgent and appropriate responses and measures to curtail and
eliminate the COVID -19 threat;
WHEREAS, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases
(IATF-EID) National Action Plan identifies the development of minimum public health standards as
the backbone of the Philippine response to the COVID-19 outbreak;
WHEREAS, on 27 April 2020, the Department of Health (DOH) released Administrative Order No.
2020-0015 or Guidelines on the Risk-Based Public Health Standards for COVID-19 Mitigation which
outlines non-pharmaceutical interventions (NPI) or public health strategies to mitigate and suppress
transmission of infectious diseases. This includes engineering controls, such as placement of
handwashing facilities across public settings, to improve personal hygiene;
WHEREAS, the World Health Organization (WHO) and the DOH highly encourage the improvement
of handwashing facilities and the use of proven behavior-change techniques to enable more frequent
and proper hand hygiene as one of the most important measures in preventing COVID-19 infection;
WHEREAS, the Implementing Rules and Regulations of the Sanitation Code of the Philippines
(Presidential Decree No. 856) includes provisions on the installation and maintenance of
handwashing facilities or lavatories under the section on Sanitary Facilities Requirements in various
settings;
WHEREAS, the Local Government Code of 1991 (Section 16. General Welfare) provides that local
governments shall exercise powers necessary, appropriate or incidental for its efficient and effective
governance, and those which are essential to the promotion of the general welfare. Further, within

their respective territorial jurisdictions, local government units shall ensure and support, among
other things, the promotion of health and safety;
WHEREAS, the Local Government Code of 1991 (Section 17. Basic Services and Facilities) also
states that local governments are granted powers to discharge functions and responsibilities to
provide basic services and facilities. At the barangay, municipal or city levels, these include services
and facilities related to general hygiene and sanitation, beautification, and solid waste collection, as
well as programs and projects on communicable and non-communicable disease control services;
WHEREAS, with these powers, this [Province/City/Municipality] implements the installation of

behavioral nudges in public handwashing facilities using this Ordinance’s procedures and technical
specifications necessary for the adaptation and transition into the “New Normal.”
NOW, THEREFORE, be it ORDAINED by the Sangguniang [UNIT] of the [LGU]:

Ordinance No. [___]
Series of [___]
AN ORDINANCE ENACTING THE INSTALLATION OF BEHAVIORAL NUDGES

IN PRIORITY SETTINGS
CHAPTER I. GENERAL PROVISIONS
Section 1. Short Title. This ordinance shall be known and cited as the Hygiene Behavioral Nudges
Ordinance of [Year].
Section 2. Declaration of Principles and Policies. It is the policy of the [Province/City/Municipality]

to promote the health and safety of its constituents through the provision of basic services and
facilities related to sanitation and hygiene. Towards this end, the [Province/City/Municipality] shall
adopt:
a. Evidence-based, low-cost, and easily scalable behavioral nudges which institutionalize the
promotion and practice of proper hand hygiene and infection prevention and control
measures in priority settings; and
b. A behavior-centered design approach to changing attitudes and behavior towards frequent
and proper handwashing and other hygiene practices in line with national efforts to shift into
the New Normal.
Section 3. General Objectives. This Ordinance seeks to:
a. Reinforce the provision or establishment of functioning and well-maintained handwashing

facilities with soap and water and/or sanitation stations with alcohol-based hand rub
dispensers in priority settings;
b. Promote proper sanitation and hygiene behavior through appropriate, well-designed
behavioral nudges which influence and encourage proper handwashing and other hygiene
practices;
c. Prevent and control the transmission of COVID-19 and other infectious diseases by
providing strategic interventions to cue proper hygiene behavior in priority settings of the
[Province/City/Municipality];
d. Provide a safe environment for all people, especially vulnerable groups, such as the elderly,
pregnant women, and immunocompromised individuals, to conduct essential activities in the
New Normal.
Section 4. Scope and Coverage. This Ordinance shall include and cover:
a. Priority settings, primarily, but not limited to: (i) Schools; (ii) Offices and Workplaces; (iii)
Public Markets and Grocery Stores; (iv) Food and Service Establishments; (v) Temporary
Shelters and Evacuation Centers; (vi) Public Spaces (e.g. Malls, Hotels and Other
Accommodations, Transport Terminals and Ports of Entry, Churches and Places of Worship,
Government Centers and Offices, Historical and Heritage Sites, Local Tourist Destinations,
Sports and Recreational Spaces); (vii) Hospitals, Health Centers and Rural Health Units;
within the territorial jurisdiction of [LGU];
a. Establishment of functioning, accessible, and well-maintained handwashing facilities with
soap and water and/or sanitation stations with alcohol-based hand rub dispensers within the
premises of aforementioned priority settings and other public spaces identified by the
[Province/City/Municipality], as well as the implementation of behavioral nudges which
influence and encourage proper handwashing and other hygiene practices.

Section 5. Definition of Terms. As used in this Ordinance, the following terms shall mean:
a. Behavioral Nudges are small changes to the environment that alter behavior in a predictable
way but do not explicitly constrain choices.
b. Behavioral Nudge Master Plan refers to the comprehensive implementation and evaluation
plan for the installation of behavioral nudges, which includes stakeholder consultations,
selection of priority settings and strategic areas for hand hygiene facilities, development of
nudge materials, pilot testing, and identification of budget items or sources, among others.
c. Behavior-Centered Design (BCD) is an approach developed at the London School of
Hygiene and Tropical Medicine. BCD draws on evolutionary psychology, the latest techniques
in marketing and existing behavior change approaches. BCD is concerned with how design
can shape, or be used to influence human behavior.
d. Infection Prevention and Control (IPC) is the discipline concerned with preventing
healthcare-associated infection
e. New Normal refers to the emerging behaviors, situations, and minimum public health
standards that will be institutionalized in common or routine practices and remain even after
the pandemic while the disease is not totally eradicated through means such as widespread
immunization. These include actions that will become second nature to the general public as
well as policies such as bans on large gatherings that will continue to remain in force.
f. Non-pharmaceutical Interventions (NPI) refers to public health measures that do not involve
vaccines, medications or other pharmaceutical interventions that individuals and communities
can carry out in order to reduce transmission rates, contact rates, and the duration of
infectiousness of individuals in the population.
g. Vulnerable groups are socially disadvantaged groups that are most susceptible to suffer
directly from disasters and health events. These include senior citizens, immunocompromised
individuals, women, children, persons deprived with liberty (PDL), persons with disabilities
(PWDs), and members of indigenous peoples(IPs), internally displaced persons (IDPs),
indigenous cultural communities (ICCs), among others.
CHAPTER II. ROLES AND RESPONSIBILITIES
Section 6. [Provincial/City/Municipal] Health Office. As the principal implementer of this Ordinance,

the [Provincial/City/Municipal] Health Office shall lead the development and installation of
behavioral nudges in priority settings. In this capacity, the Office shall undertake the following:
a. Lead the development of the Behavioral Nudge Master Plan, in collaboration with the Local
Health Board, local implementers, representatives of relevant government agencies (DepEd,
DILG), local businesses/ establishments related to identified settings, vulnerable or
marginalized sectors (women, youth, elderly, PWDs), local people’s organizations, and
schools;
a. Identify priority settings covered by this Ordinance in which handwashing facilities or
sanitation stations shall be available and accessible, and behavioral nudges shall be
installed;
b. Execute appropriate strategies for the development of technical and design specifications of
behavioral nudges suitable for each identified installation area, and for the pilot testing of
customized designs within controllable and observable settings, if applicable;
c. Prepare costing for behavioral nudge materials to be produced and other related activities to
be conducted, including installation of handwashing facilities and/or sanitation stations and
procurement of supplies (e.g., alcohol, soap, single-use towels) as needed, and facilitate all
necessary financial documentary requirements;
d. Facilitate the conduct of capacity building activities for identified local implementers (e.g.,
C/MHOs, HEPOs, Sanitary Engineers & Inspectors, Public Health Nurses, etc.) to ensure

effective development and implementation of the intervention
e. Produce and install behavioral nudges in identified settings with handwashing facilities
and/or sanitation stations;
f. Develop and oversee communication efforts, community engagement activities, and
auxiliary programs, projects, and activities as applicable;
g. Develop and implement a local monitoring system for routine inspection, maintenance, and
evaluation of installed behavioral nudges;
h. Oversee monitoring and evaluation activities related to the implementation of this Ordinance
and analyze results to determine necessary next steps, such as adjusting/modifying existing
set of nudges, redesigning, or installing a new set of nudges, and frequency of such actions;
i. Consolidate and discuss findings and recommendations with local implementers, the Local
Health Board, and stakeholders for any necessary adjustment of the Behavioral Nudge
Master Plan.
CHAPTER III. BEHAVIORAL NUDGES IN PUBLIC SPACES
Section 7. Establishment and Maintenance of Enabling Environment. The [Province/City/

Municipality], in support of the installation of behavioral nudges in priority settings, shall endeavor
to:
a. Establish and properly maintain handwashing facilities and/or sanitation stations within the
premises of priority settings covered by this Ordinance and other public spaces identified by
the [Province/City/Municipality].
b. The placement and design of handwashing facilities shall be carefully considered, especially
when permanent structures are built. The following must be taken into account:
i. Proximity to locations where handwashing should occur so they are able to
contribute to breaking the transmission cycle of disease;
ii. Ample space must be available for the facility and this space must also consider the
safety and security of users and shall not cause obstruction;
iii. Foot traffic in the area, such that facilities must be in spaces frequented by people;
iv. Access to tappable water lines and drainage systems;
v. Appeal, affordability, and ease of maintenance;
vi. Consider if roofing above the facility is needed to protect from the weather and other
elements.
c. Ensure there is sustained access to a regular supply of water sufficient for handwashing and
other personal hygiene needs;
d. Ensure the consistent availability of soap and alcohol-based hand rub in handwashing
facilities and sanitation stations. Systems shall also be in place for regularly monitoring and
replenishing the supply of such;
e. Install drying equipment and/or provide supplies such as single-use paper towels that can
be used to dry hands. Ensure regular maintenance of equipment and replenishment of
supplies;
f. Ensure that handwashing facilities and sanitation stations are free from any obstructions and
accessible to all people regardless of age, gender, or disability. This can be done by placing
clear paths or ramps, small foot stools, or adjusting the height and size of the facility, among
others.
Section 8. Behavioral Nudges. Once hand hygiene infrastructure and supplies are deemed
functional and accessible, appropriate behavioral nudges which alter the physical and social
environment to encourage proper handwashing and hygiene practices shall be installed in
handwashing facilities and sanitation stations in areas covered by this Ordinance.

a. Principles for Planning and Design. In the planning of behavioral nudges, the
[Provincial/City/Municipal] Health Office shall employ strategies which include observation
and engagement with target audiences in order to identify appropriate behavioral nudge
designs suitable for different priority settings and ready to be widely rolled out. The
following aspects and principles shall be considered to ensure the suitability and
effectiveness of the nudges to be implemented and/or designed:
i. Behavior-Centered Design. Interventions meant to change behavior, such as

nudges, must have an approach that is surprising to target audiences, causes a
re-evaluation of the desired handwashing behavior, and ensures that it is more likely
to win out as the best behavioral choice when the next opportunity arises.
ii. EAST Principles. Nudges must be easy, attractive, social, and timely. Behavioral
nudges shall be devised with simple and clearly understandable messaging,
eye-catching and attractive colors and designs, and a social dimension to reinforce
handwashing behavior as a norm. These shall also be positioned in areas where
target audiences are more receptive to the nudge, such as outside toilet cubicles or
at entrances of dining areas.
iii. Resources and Environment. Costs of installing and maintaining the different
nudges and cues shall be considered in the selection and development of
interventions. Affordability, availability, and feasibility of producing the materials
locally shall also be taken into account, as well as the conduciveness of specific
environments in which the nudges are to be installed.
iv. Inclusivity. Nudges must also be inclusive and consider how all target audiences in
the different settings and spaces will be able to interact with these. Similar to
handwashing facilities and sanitation stations, nudges installed in these areas must
be free from obstructions and shall appropriately cater to age, gender, or disability of
users.
Section 9. Maintenance and Reinstallation. The [Province/City/Municipality], through the

[Provincial/City/Municipal] Health Office or other such relevant offices, shall strictly implement a
local monitoring system which considers the estimated life of the nudges and handwashing facilities
where they are installed, estimated cost of maintenance and repair, and availability of resources for
such.
a. Based on this system, the designated office or individuals shall routinely inspect and assess
whether behavioral nudges and the handwashing facilities or sanitation stations where they
are installed are in need of maintenance, repair, or reinstallation.
b. Maintenance works for facilities and nudges include, but are not limited to, cleaning,
de-clogging, fixing leaks, repainting, and refilling paper towel, soap, or hand rub dispensers.
Section 10. Auxiliary Programs, Projects, and Activities. The [Province/City/Municipality], in

support of the installation of behavioral nudges in priority settings, shall endeavor to develop
multimodal strategies to further encourage and sustain proper hand hygiene behavior, such as, but
not limited to:
a. Promoting proper sanitation and hand hygiene among households, office workers, and
students by investing in and strategically distributing free hygiene kits;
b. Exploring incentive mechanisms to encourage private entities, business establishments, and
other commercial facilities to ensure availability of hand hygiene infrastructure and supplies,
to install behavioral nudges, and to implement other innovative hand hygiene measures;
c. Undertaking research to identify key determinants of hand hygiene behavior for specific local
contexts and settings in order to develop interventions complementary to nudges, such as

awareness campaigns, practical demonstrations, or using role models to promote hand
hygiene;
d. Integrating proper sanitation and hygiene norms into school or workplace policies;
e. Conducting capacity building activities to enable faculty/staff/employees to effectively teach
and promote proper sanitation and hygiene;
f. Promoting proper and regular handwashing practice through a communication strategy
which includes disseminating materials in local television and radio stations, print media, and
social media channels and conducting community activities such as caravans or bandilyos to
play jingles reminding people to wash their hands with soap and water.
Section 11. Mandatory Installation of Hygiene Behavioral Nudges. The [Province/City/

Municipality] may endeavor to require the installation of behavioral nudges in handwashing facilities
and sanitation stations, as a regulatory requirement prior to the reopening of schools, operation of
establishments, or renewal or issuance of local Sanitary and/or Business Permit/s to offices,
establishments, buildings, and other areas covered by this Ordinance.
CHAPTER IV. ENFORCEMENT AND PENALTIES
Section 12. Enforcement and Penalties. The following shall be observed in the enforcement of this
Ordinance and other existing rules related to the installation of behavioral nudges in priority
settings:
a. Violation of, disobedience, refusal, omitting or neglecting to comply with any of the rules and
regulations promulgated under the Sanitation Code of the Philippines shall be considered as
misdemeanor and upon conviction shall be punished by imprisonment for a period not
exceeding six (6) months or by a fine not exceeding P1000.00 or both depending upon the
discretion of the court.
b. Interference with, hindrance, or opposition to any officer or representative of the Department
or the [Provincial/City/Municipal] Health Office, in the performance of his duty as such
under the Sanitation Code and this Ordinance, shall be considered as misdemeanor, and
shall be punishable upon conviction by imprisonment for a period not exceeding six (6)
months or by a fine not exceeding P1000.00 or both depending upon the discretion of the
court.
c. Tearing down, mutilation, defacement or alteration of any placard or notice affixed to the
premises in the enforcement of the Sanitation Code shall constitute misdemeanor and be
punishable upon conviction by imprisonment for a period not exceeding six (6) months or by
a fine not exceeding P1000.00 or both depending upon the discretion of the court.
d. Defacement, vandalism, or removal of installed behavioral nudges or any damage to
handwashing facilities and sanitation stations shall be considered as special cases of
malicious mischief or damage to public property under The Revised Penal Code (Act No.
3815 and R.A. No. 10951) and existing [Provincial/City/Municipal] ordinances, and shall be
subject to appropriate action and penalties.
e. Unlawful taking of supplies or equipment from handwashing facilities and sanitation
stations, such as, but not limited to soaps, alcohol-based hand rubs, paper towels, hand
dryers, soap dishes, dispensers, faucets, and pipes, shall be considered as theft under The
Revised Penal Code and existing [Provincial/City/Municipal] ordinances, and shall be
subject to appropriate action and penalties.

CHAPTER V. MONITORING
Section 13. Reporting and Monitoring. The [Provincial/City/Municipal] Health Office shall lead and
oversee the regular monitoring and evaluation of the implementation of the behavioral nudge
intervention. It may designate other relevant office/s or individuals to carry out monitoring activities
in the different priority settings and strategic areas provided that all data gathered shall be
submitted to and consolidated by the [Provincial/City/Municipal] Health Office for regular reporting
to the Local Health Board. These data shall also be used to decide on necessary actions, such as
adjusting or modifying existing set of nudges, redesigning, or installing a new set of nudges, and the
frequency of such actions.
CHAPTER VI. APPROPRIATIONS
Section 14. Appropriations. The funding necessary to implement the provisions of this Ordinance, to
install behavioral nudges, and implement other related activities, as determined by the
[Provincial/City/Municipal] Health Office in its approved Work and Financial Plan shall be
earmarked annually and may be sourced from the following, in order of priority:
a. The LGU’s annual Internal Revenue Allotment (IRA);

b. National Government Agency (NGA) subsidy to related programs, projects, and activities
through the relevant agencies; and
c. Supplemental funding requests from relevant NGAs.
CHAPTER VII. FINAL PROVISIONS
Section 15. Implementing Rules and Regulations (IRR). The [Governor/Mayor] may issue
appropriate and relevant rules and regulations, as necessary for the proper implementation of any
and all provisions of this Ordinance.
Section 16. Repealing Clause. All other orders and issuances, as well as pertinent rules and
regulations thereof, which are inconsistent with any of the provisions in this Ordinance are hereby
repealed or amended accordingly.
Section 17. Effectivity. This ordinance shall take effect (immediately upon its approval OR on [date]/
after [number of days] following its publication in a newspaper of general circulation and posting in
conspicuous places in the Province/City/Municipality).
CARRIED [UNANIMOUSLY OR ON A MAJORITY VOTE].
(If on a majority vote:

In favor:
Abtension:
Against:)
CERTIFIED TRUE AND CORRECT:
[NAME]
Secretary

ATTESTED:
[NAME]
Vice [Governor/Mayor], Presiding Officer
[NAME]
[Governor/Mayor]
Date of Approval : ____________

Date of Posting : ____________
Date of Publication : ____________
Date of Effectivity : ____________

Annex B. Implementers’ Guide to Behavioral Nudges
DECISION TOOL
Figure 1. Enabling environments for nudge-based handwashing intervention

Adapted from: Using Environmental Nudges to Improve Handwashing with Soap (Hygiene Hub, 2020)
Once hand hygiene infrastructure and supplies are deemed functional and accessible,
appropriate behavioral nudges which alter the physical and social environment to
encourage proper handwashing and hygiene practices shall be installed in handwashing
facilities and/or sanitation stations in areas covered by this intervention.

TYPES OF BEHAVIORAL NUDGES
Behavioral nudges to be installed shall belong to one or more of the following categories:
contextual clues, or visual reminders. Each type comes with sample designs (see link:
http://tinyurl.com/BehavioralNudgeDesigns) and recommendations for how and where to
install them. Implementers may opt to adopt the following nudges but are highly
encouraged to develop their own to better suit their context and settings.
CONTEXTUAL CLUES
Directional Designs
A brightly colored path, arrows, footprints, or similar directional designs painted or stuck to
the floor or any flat surface leading towards the handwashing facility and/or sanitation
station. This may be useful especially when handwashing facilities are separated from
toilets or other areas in which key moments of hand hygiene must be practiced.
Recommended application: on floors leading to

handwashing facility or sanitation station; above items
needing emphasis (soap dish, foot pedals, etc.)
Recommended settings: public spaces, schools
Recommended application: on floors leading to

handwashing facility or sanitation station
Recommended settings: public spaces, schools,
workplaces

Improved Facilities
Clean and well-maintained facilities encourage proper hand hygiene behavior.
Mirrors. Handwashing facilities

equipped with a mirror located
above the sink or tap at eye-level
of its target audience. This can be
done to encourage people to
spend more time in the facility
and while washing their hands,
more likely ensuring proper and
thorough handwashing.
Recommended application: above
faucets or taps; on walls near
handwashing facility
Recommended settings: schools,
workplaces
Emphasis and Appeal of Soap. For greater appeal,

fragrant and colorful soaps, alcohol-based hand rubs,
or other cleansing agents can be placed in
handwashing facilities and sanitation stations and
regularly replenished. For facilities that are not solely
used for handwashing purposes, arrows or any
indicators shall be placed near a brightly colored soap
dish or dispenser to exclusively draw attention to it.
When appropriate and practical, soap bars may also
contain items to pique the interest of and incentivize
users to consistently use soap in handwashing.
Paper Towels. Dispensers for

paper towels shall be placed in
handwashing facilities as a
reminder for people to practice
handwashing using soap and
water. In settings with higher
resource availability, automatic
paper towel dispensers shall be
installed.
Handwashing Kiosk with Reminders. In areas with no existing facilities, a handwashing

station specifically designed for the WASH O’Clock Campaign (see link:
https://bit.ly/WashOClockCampaignMaterials) can be set up. These attractive and
colorful facilities are fully-equipped with a foot pedal operator to minimize touching of

surfaces, messaging on washing hands during critical moments, a short reminder to wash
hands with soap for 20 seconds, a 5-step guide for proper handwashing, and liquid soap
and tissue dispensers.
● Recommended application: near entrances of identified public spaces
● Recommended settings: public spaces, transit hubs/terminals, public markets,
government offices, health centers, churches, malls, and food courts/restaurants
VISUAL REMINDERS
Visual Prompts
Handprints. Brightly colored handprints shall be painted or stuck on or above the sink or
tap of a handwashing facility and within the vicinity of a sanitation station to cue hand
hygiene behavior.
Recommended application: on handwashing facility or sanitation station
Recommended settings: public spaces, schools

“Watchful Eyes”. Stickers, photos,
or decals depicting a pair of
“watchful eyes” shall be attached
to a surface above or near the
handwashing facility and/or
sanitation station to create the
sense that others are observing
and expecting to see proper hand
hygiene behaviors.
Recommended application: on
bathroom mirrors, above
handwashing facility
Recommended settings: public
spaces, schools, workplaces
Germ Stickers. Disgust-inducing images of germs and viruses shall be placed or stuck
onto frequently touched surfaces, such as comfort room door handles, toilet cubicle doors
and locks, and toilet flushes, among others.
Recommended application: on high-touch surfaces: doors, handles, counters
Recommended settings: public spaces, schools, workplaces
Simple Handwashing Reminders and Messages
A simple poster promoting handwashing or sanitizing using

alcohol-based hand rubs shall be displayed in highly visible
areas within or near the handwashing facility or sanitation
station. The poster shall not serve as an education tool and
shall not be loaded with information. It must be surprising and
grab people’s attention through large and clear texts, bold
colors, or easily understandable images and graphics.
Recommended application: on high-touch surfaces or
highly-visible places near handwashing facility
Recommended settings: public spaces, schools, workplaces

Recommended application: in highly visible places near handwashing facility; behind
bathroom stall doors
Recommended settings: depending on the critical moment for handwashing being referred
to (e.g., Bago Kumain - food courts, restaurants; Namalengke Ka Mars - public markets,
groceries; Sabi ni Doc - hospitals, health centers, rural health units; Pagkatapos Bumiyahe -
transit hubs, terminals)
Recommended Auxiliary Health Promotion Activities
In addition to installing behavioral nudges – which, on its own, is not enough to

change and sustain the desired behavior of observing proper hand hygiene,
implementers may also develop multimodal strategies and initiate complementary
health promotion activities.
● Promoting proper sanitation and hand hygiene among households, office

workers, and students by investing in and strategically distributing free hygiene
kits
● Exploring incentive mechanisms for private entities, business establishments,
and other commercial facilities to ensure availability of hand hygiene
infrastructure and supplies and to implement their own hand hygiene measures
● Undertaking research to identify key determinants of hand hygiene behavior for
specific local contexts and settings
● Integrating proper sanitation and hygiene norms into school or workplace
policies;
● Promoting proper and regular handwashing practice through a communication
strategy including airing of materials in local television and radio stations and
through print media and social media channels. Community activities such as
caravans or bandilyos to play jingles on handwashing, motorcades and others to
remind people to wash their hands with soap and water.
● Conducting capacity building activities to enable faculty/staff/employees to
effectively teach and promote proper sanitation and hygiene

Annex C. Template Nudge Designs and Communication Materials
Materials Link Sample/Application
Sample Set of http://tinyurl.com/Behavioral See Implementers’ Guide section

Behavioral Nudge NudgeDesigns
Designs
BIDA Solusyon Plus BIDA Decals/Stickers

sa COVID-19 http://bit.ly/BIDAassets
http://bit.ly/BIDAallFiles
http://bit.ly/BIDAsocmed
http://bit.ly/BIDAsocmed

WASH O’Clock https://bit.ly/WashOClockCa
Campaign mpaignMaterials
● Signages for
Public Utility
Vehicles
● Poster, Stickers,
or Vinyls/
Tarpaulins
● Jingles

Annex D. Monitoring and Evaluation Reporting Template
For an editable version of this plan and the following monitoring forms, please visit: https://tinyurl.com/PA2Playbook-TemplateMonitoring
BASELINE/ DATA FOR PERCENT OF

ORDINANCE OBJECTIVES INDICATOR OVERALL TARGET PREVIOUS CURRENT TARGET RESPONSIBLE
DATA PERIOD ACHIEVED
Promote sanitation and Two (2) hour usage rate of

hygiene through appropriate, handwashing facilities and sanitation
well-designed behavioral stations with behavioral nudges
nudges which encourage installed
proper handwashing and (actual vs. potential users)
other hand hygiene practices
Number of bar soaps or volume of
liquid soap used
Water meter reading (if dedicated

meter installed)
Reinforce the establishment Number of existing and new

and maintenance of handwashing facilities and sanitation
functional handwashing stations in identified priority settings
facilities and sanitation
stations in priority settings
Prevent and control the Number of new confirmed COVID-19

transmission of COVID-19 cases
and other infectious diseases
by providing strategic
interventions to cue proper Incidence of infectious diseases related
hygiene behavior in priority to hand hygiene (i.e. gastrointestinal
settings and respiratory illnesses)

Annex E. Facility Observation and Spot-Check Template
Facility Name: Dates/Period Covered:
A: Behavior/Kilos 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Within the duration of two (2) hours:

Sa loob ng dalawang (2) oras:
Number of actual users (washed with soap and

water/sanitized with alcohol-based hand rubs)
Bilang ng taong gumamit ng pasilidad
(naghugas gamit ang sabon at
tubig/nag-sanitize ng kamay)
Number of potential users (persons who

passed by or are within the vicinity of the
handwashing facility/sanitation station)
Bilang ng taong maaaring gumamit ng
pasilidad (dumaan o nasa paligid ng hugasan
ng kamay)
Number of users observed practicing proper

handwashing steps (refer to next observation
form)
Bilang ng taong naobserbahang gumagawa ng
tamang paghuhugas ng kamay
Number of observations made

Bilang ng taong inobserbahan

B: Facility/Pasilidad 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Complete and functional faucets

Kumpleto at gumagana nang maayos ang mga
gripo
Sufficient and stable running water

Sapat at hindi nawawala ang daloy ng tubig
Soap is available and sufficient (indicate below

when replaced)
Mayroon at sapat ang sabong magagamit
(ilagay sa baba kung kailan pinalitan ng bago o
nag-refill)
Clean tiles, sink, and surroundings

Malinis ang mga tiles, lababo, at kapaligiran
Properly installed behavioral nudge materials

and signages are present and legible
Maayos at malinaw na nababasa ang mga
nakapaskil na paalala at behavioral nudges
a. Directional Designs (arrows, footprints,

etc.)
a. Handprints
a. “Watchful Eyes”
a. Germ Stickers

a. Simple Handwashing Reminders and
Messages
a. Improved Facilities (mirrors, soap

dispenser/dish, paper towels)
a. Other signages, posters, IEC materials
Clear drainage, free of debris

Malinis ang paagusan at walang duming
nakabara
Accessible and free from obstructions

Madaling puntahan o gamitin ng lahat at
walang nakaharang sa daan
Additional Observations, Comments, Recommendations
End-of-Month Water Meter Reading:
Date/s of Soap Refill/Replacement:
_________________________________________ _________________________________________
Name and Signature of Monitoring Officer Name and Signature of Monitoring Officer

Annex F. Proper Handwashing Observation Forms
Proper handwashing observation (use as much as you need to complete your 2-hour observation per day)
Only record the ones that you were able to observe from start to end
1 2 3 4 5 6 7 8
Rinse well with
Observation Gender Washed the Washed the Scrub the nails/ Wash for at
Used both Scrub each water and dry
No. (M/F) palms of the back of the tips of the Wash the wrist least 20
water and soap finger using a single-use
hand with soap hand with soap fingers seconds
towel/tissue
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL
RATIO OF
COMPLIANCE
(%)

Annex G. Intercept Survey Form Template
For an editable version of this plan and the following monitoring forms, please visit:
https://tinyurl.com/PA2Playbook-TemplateMonitoring
Hi. You are selected and invited to participate in this research study because your opinions
and experiences matter to us. The purpose of this research is to understand your habits and
perception on your personal hygiene so we can maximize our communication campaign
efforts. This research is being conducted by [Name of LGU].
Your participation in this research study is voluntary. You may choose not to participate. If
you decide to participate in this research survey, you may withdraw at any time, and you
will not be penalized.
The study involves answering a survey that will take approximately five (5) minutes. If
there are questions you do not want to answer, you may exit or stop the survey anytime
and the information that you’ve given so far will be deleted. Your responses will be
confidential, and your answers will not be analyzed on its own but will be analyzed
together with the other responses. The information that we collect will not be shared with
or given to anyone except for the research team. The results of this study will be used for
research purposes only. Rest assured that the data will be securely stored (password
protected electronic format) in accordance with the 2012 Data Privacy Act. Any personal
identifiable information gathered from this study will only be stored for one (1) year. As
part of your rights as stated in the Data Privacy Act, you have the right to object or withhold
your consent to processing the data in case of changes to the information that have been
provided.
If you have any questions about the research study, please contact [Name of Lead
Implementer], [Position] via mobile: __________ or through email at: _________.
Lastly, your consent in participating in this study is only valid for ____ months. This covers
the total duration of this study.
A copy of this consent will be given to you after you have submitted your answers.
Please select your choice below.

Encircled "agree", code 1 below indicates that:
● You have read the above information/ the above information has been read to you
● You voluntarily agree to participate
● You are at least 18 years of age
If you do not wish to participate in the research study, please decline participation by
encircling on number “2” for "disagree" then return the survey form.
Agree 1
Disagree 2

Name: ___________________________________________________________________________
Interviewer Name: ________________________________________________________________
Date: ______________________ Survey Location: _____________________________________
Gender: ____________________ Age: ______________________
FOR THE FOLLOWING QUESTIONS, PLEASE ENCIRCLE YOUR ANSWER
S1. What is your current occupation?____________________________________________

Professional/technicians/
1 Skilled manual 5
managers
Clerical support workers 2 Laborer and unskilled workers 6
Sales and service workers 3 Domestic service 7
Skilled agricultural, forestry
Armed forces occupations 4 8
and fishery workers
Others, please specify Others, please specify
S2. What is your household’s total monthly income? (please include all income sources)
10,000 or less 1 50,001 to 70,000 4
10,001 to 25,000 2 70,001 to 100,000 5
25,001 to 50,000 3 100,001 and above 6
S3. Which of the following applies to you currently? Please select all that apply
Commuter – uses public transportation at least 4 days a week 1
Works in a healthcare facility like hospitals, clinics, etc. 2
Local government official – works in the local government like city hall,
3
municipal hall, barangay hall, etc.
Works in the transportation sector - in-charge or works in a public
4
transportation fleets or transport stations
Works in a private sector business 5
Parent/ Legal guardian with school-age child/ren 6
None of these 7
Now let’s talk about your hand washing experience.

A1. Please list down all the occasions/situations when you normally wash your hands.
A2. How much do you agree or disagree with the following statements on hand washing?
Please select one answer only per statement.
Strongly Strongly
Disagree Neutral Agree
Disagree Agree
I am able to wash my hands
1 2 3 4 5
with soap and water during

critical moments (ex. before
eating, after using the toilet)
Hand washing/ sanitizing
helps prevent diseases/ 1 2 3 4 5
infection
It is a disadvantage for a
public place to not have a 1 2 3 4 5
handwashing station
A3. How often do you wash your hands outside your home using public handwashing
facilities?
Never Seldom Sometimes Often Always
1 2 3 4 5
ASK A4 IF WASHING HANDS OUTSIDE CODE 2-5 IN A3

A4. You mentioned that you wash your hands using public handwashing facilities. May I
know why you wash your hands when outside? What is the reason why you wash your
hands? Anything else?
ASK A5 IF NOT WASHING HANDS OUTSIDE CODE 1 IN A3

A5. You mentioned that you DO NOT wash your hands using public handwashing facilities.
May I know why you do not wash your hands when outside? What is the reason this is so?
Anything else?
A6. Please rank the following based on the most encouraging item that will make you
wash your hands using a public handwashing facility where 1 is the most encouraging, 2 is
the second encouraging and so on.
Clean water
Soap
Tissue/ Towel
Poster/Signages
Nice facility
Clean area
Other (please specify)

In this section, we’ll talk more about handwashing.
B3. Now, have you seen or heard any WASH O’CLOCK advertisement/posters/
messages/reminders, etc. in the past month?
Yes 1 CONTINUE TO B4
No 2 CALL THE INTERVIEWER
B4. What was the kind of advertisement that you saw?

Television ad 1 Handwashing stations 8
TV show placement 2 Radio ad 9
Signages o posters 3 Jingle or song 10
Facebook post 4 Stickers 11
Facebook ad 5 Tarp signages 12
Youtube video 6 Caravan/ Roving 13
Other social media
Youtube ad 7 14
ads/posts
Others, please specify
B5. What was the message of the advertisement besides telling you to wash your
hands? Please tell us everything that you remembered.
B6. How much do you like or dislike the ad?

Dislike it very Dislike it Neither like Like it Like it very
much moderately nor dislike it moderately much
1 2 3 4 5
B7. After seeing the ad, which of the following did you do? Please select all that apply
Immediately washed my hands with soap 1 GO TO B8
Immediately used/rub alcohol or hand sanitizer 2
Shared the ad to others 3
GO TO B9
Talked about the ad to others 4
Reminded others to properly wash their hands 5
Became more conscious when washing my hands 6
GO TO B8
Follow proper hand washing with soap and water 7
I didn’t do anything special 8 GO TO B9
Other (please specify)
GO TO B9

ANSWER B8 IF YOU’VE WASHED YOUR HANDS AFTER SEEING THE AD (CODE 1, 6,
7). IF NOT, SKIP TO B9.
B8. What about the ad encouraged you to wash hands?
Message – what is written in the ad 1
Colorful design 2
AFTER
Pictures/images 3
ANSWERING,
Handwashing station 4
PLEASE SKIP
Song/jingle 5
TO B10
Others (please specify)
ANSWER ONLY B9 IF YOU DIDN’T WASH YOUR HANDS AFTER SEEING THE AD
(CODE 2-5, 8). IF YOU WASHED YOUR HANDS, PLEASE SKIP TO B10.
B9. Why didn’t you wash your hands with soap after seeing the ad? Please tell us all
the reasons why.
B10. Seeing these WASH O’Clock campaign materials here, do you have any comments,
suggestions or recommendations?
That’s all for today! Thank you again for your time.

References
1. Coultas, M., Iyer, R., & Myers, J. (2020). visitors’ hand sanitizer use. Behavioral Science &
Handwashing compendium for low resource Policy. https://behavioral
settings: A living document, edition 2. The policy.org/journal_issue/covid-19/
Sanitation Learning Hub, Institute of Development
9. Hermann, C. (n.d.). Impact of a voice on hand
Studies.
hygiene. Clean Hands, Safe Hands.
https://www.ids.ac.uk/publications/handwashing-c
https://cleanhands-safehands.com/impact-of-a-voi
ompendium-for-low-resource-settings-a-living-do
ce-on-hand-hygiene/
cument/
Other references or further reading:
2. Philippine Statistics Authority and ICF. (2018).
Biran, A., Schmidt, W-P., Varadharajan, K.S.,
Philippines national demographic and health
Rajaraman, D., Kumar, R., Greenland, K., Gopalan,
survey 2017.
B., Aunger, R., & Curtis, V. (2014). Effect of a
https://psa.gov.ph/sites/default/files/PHILIPPINE%
behaviour-change intervention on handwashing
20NATIONAL%20DEMOGRAPHIC%20AND%20
with soap in India (SuperAmma): A
HEALTH%20SURVEY%202017_new.pdf
cluster-randomised trial. The Lancet Global
3. Mosler, H-J. (2012). A systematic approach to Health, 2(3), e145–e154.
behavior change interventions for the water and https://doi.org/10.1016/S2214-109X(13)70160-
sanitation sector in developing countries: A 8
conceptual model, a review, and a guideline.
Curtis, V.A., Danquah, L.O., & Aunger, R.V. (2009).
International Journal of Environmental Health
Planned, motivated and habitual hygiene
Research, 22(5), 431–449.
behaviour: an eleven country review. Health
https://doi.org/10.1080/09603123.2011.650156
Education Research, 24(4), 655–673.
4. Thaler, R.H., & Sunstein, C.R. (2008). Nudge: https://doi.org/10.1093/her/cyp002
Improving decisions about health, wealth, and
De Buck, E., Van Remoortel, H., Hannes, K., Govender,
happiness. Yale University Press.
T., Naidoo, S., Avau, B., Vande veegaete, A.,
5. Palomares, A. (2019, October 14). Understanding Musekiwa, A., Lutje, V., Cargo, M., Mosler, H-J.,
the use of nudges in handwashing behavior Vandekerckhove, P., & Young, T. (2017).
change programs: Highlights from the 2019 UNC Approaches to promote handwashing and
Water and Health Conference. R&E Search for sanitation behaviour change in low- and
Evidence. middle-income countries: A mixed method
https://researchforevidence.fhi360.org/understandi systematic review. Campbell Systematic Reviews,
ng-the-use-of-nudges-in-handwashing-behavior- 13(1), 1–447. https://doi.org/10.4073/csr.2017.7
change-programs-highlights-from-the-2019-unc-
World Health Organization. (2020, March 11). WHO
water-health-conference
Director-General's opening remarks at the media
6. Le, N., & Huang, C. (2020, May 15). Designing for briefing on COVID-19 [Speech].
behavior change: Lessons learned from nudging https://www.who.int/dg/speeches/detail/who-dire
Filipino students to wash their hands. Medium. ctor-general-s-opening-remarks-at-the-media-br
https://medium.com/idinsight-blog/designing-for-b iefing-on-covid-19---11-march-2020
ehavior-change-lessons-learned-from-nudging-p
Watson, J., & Dreibelbis, R. (2020). Using
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environmental nudges to improve handwashing
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with soap: A resource guide for rapidly
7. Huang, C., Le, N., & Battle, M. (2020, May 21). A deployable nudge-based interventions for use in
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features improved handwashing among Filipino [Working document]. Hygiene Hub, London
students. Medium. School of Hygiene and Tropical Medicine.
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White, S., Thorseth, A.H., Dreibelbis, R., & Curtis, V.
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(2020). The determinants of handwashing
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emphasizing social norms increased hospital


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Behavioral Nudges for Hand Hygiene 1

What is this Health Promotion Program all about?

Why implement this Health Promotion Program?

● Handwashing is one of the most effective ways to curb the transmission of

● Well-designed behavioral nudges that promote handwashing are effective,

● Behavioral nudges have a positive inﬂuence on increasing access to functional

2 Community Health Promotion Playbook

HAND HYGIENE AND BEHAVIORAL NUDGES

Critical Moments and Enabling Environments for Hand Hygiene

● Handwashing is one of the easiest and most effective defenses against

Behavioral Nudges for Hand Hygiene 3

What are Nudges?4

Nudges are deﬁned as “choice architecture that alters people’s behavior in a

There are two main types of behavioral nudges:6

4 Community Health Promotion Playbook

DepEd WASH in Schools (WinS) Policy and

● The Department of Education (DepEd) has

Behavioral Nudges in Workplaces and Hospitals

● Hospital visitor use of hand sanitizer INCREASED FROM 7% IN THE CONTROL TO

Behavioral Nudges for Hand Hygiene 5

● Increase the availability and accessibility of handwashing facilities and/or sanitation

6 Community Health Promotion Playbook

How do we ensure effective implementation of this

For an editable version of this plan, please visit: https://tinyurl.com/PA2Playbook-ImplementationPlan

1. Engage with stakeholders, target audiences, and local implementers

☐ Convene relevant stakeholders on health promotion, the

☐ Develop a Work and Financial Plan based on a

☐ Explore partnerships for the different activities involved

2. Create a Behavioral Nudge Master Plan customized to ﬁt the needs and

☐ Select priority settings - public spaces, business

8 Community Health Promotion Playbook

☐ For areas with existing facilities: Ensure that selected

For areas where facilities need to be installed: Take into

☐ Identify appropriate behavioral nudges to be installed in

Optional: Conduct pilot test for customized nudges in an

☐ Develop a communication plan and identify community

☐ Develop a monitoring and evaluation system for routine

3. Develop and facilitate the passage of a local policy to institutionalize the

☐ Refer to the Playbook’s attached template policy

Behavioral Nudges for Hand Hygiene 9

4. Prepare logistical and resource needs for the implementation of the

☐ Identify local budget items and prepare costing for

5. Conduct capacity building activities for identiﬁed local implementers

☐ Identify local implementers from the Provincial and

☐ Train identiﬁed implementers using modules available

☐ Optional: Identify other competency gaps (knowledge,

6. Implement the Behavioral Nudge Master Plan

☐ Install behavioral nudges in identiﬁed settings with Local

☐ Implement communication plan, employ communication

10 Community Health Promotion Playbook

☐ Analyze monitoring and evaluation results to determine

☐ Discuss monitoring and evaluation (See Monitoring and

☐ Accomplish necessary progress reports and

7. Auxiliary Programs, Projects, and Activities (Optional)

☐ Develop multimodal strategies to further encourage and

☐ Undertake research to identify key determinants of hand

Behavioral Nudges for Hand Hygiene 11

What is the Policy Support for this Health Promotion Program?

AN ORDINANCE ENACTING THE INSTALLATION OF BEHAVIORAL NUDGES IN

The proposed local ordinance that the Province, City, or Municipality

The following are some key provisions of this template policy:

The passage of the aforementioned Ordinance will be useful in