Handygienics

Poor sanitation and hygiene account for infections, outbreaks and deaths in the developing world like Nigeria. If infrastructural interventions will improve sanitation and hygiene, they must be accompanied by behavioural changes like handwashing, which can prevent 80% of common infections. Urbanization often causes environmental degeneration especially in the developing world where it is commonly unaccompanied by socioeconomic development and basic services; hence, diseases resulting from poor sanitation and hygienic practices are also urban problems. There is a growing number of social media users among urban populations of all regions and economies of the world. Therefore, our solution will utilize social media to improve hygienic behaviours by engaging users in activities designed to promote a lifestyle of frequent hand hygiene. Our incentive system for hand hygiene compliance will also improve equal access to healthcare. Our solution will improve disease prevention across the developing world where urban health crisis is a problem.

Poor sanitation and hygiene account for over 800,000 annually worldwide. They cause preventable diarrhoeal diseases and outbreaks like cholera and intestinal worms, which account for over 70,000 child death annually in Nigeria alone, where the open defecation rate is second highest worldwide. Although provision of WASH (water, sanitation, hygiene) facilities is the basic strategy for addressing the problem of sanitation and hygiene, stakeholders like the International Water Association (IWA) have stressed that infrastructural provisions must be accompanied by change in hygienic behaviours if WASH programs will succeed. Handwashing alone is recognized as an inexpensive hygienic behaviour that prevents 80% of common infections, especially those associated with poor sanitation and hygiene. But a 2018 global report by WaterAid indicated that only 1 in 5 people wash their hands after using the toilet. UNICEF reported that about half the population of Nigeria don't practice handwashing with soap after defecating. The WHO has identified that hand hygiene compliance is problematic worldwide even in sensitive professional sectors like healthcare despite awareness of its importance. We believe that in Nigeria and across the developing world, poor hygienic problems like hand hygiene stem from long-term persistence of lifestyles that attaches minimal importance to hygienic practices.

Our solution aims to leverage social media as a tool to improve hygienic behaviour. It is estimated that Nigeria alone has an online population of more than 90 million people, most of which constitute the urban population where mobile internet is primarily accessible. Of this, about 75% are active social media users translating to about 67.5 million people and over 13 million households across urban and peri-urban Nigeria. Therefore, our target online community comprises a significant proportion of urban populations.

Because inadequate planning and amenities enable poor sanitation and hygienic practices to thrive as urban populations rise in the developing world like Nigeria, urbanization has become a public health challenge that promotes infections and outbreaks. In the absence of sufficient strategies designed to promote hygienic practices in the context of urban settings, our solution will affect the lives of people and households in the urban developing world, where urban health crisis is a challenge and existing strategies like community-led total sanitation has limited effectiveness because it is designed for rural settings. Our social media solution will engage our target population in activities that will help them to develop a lifestyle of good hand hygiene as a strategy for disease prevention.

Our solution is a social mobile application designed to challenge participants with tasks that will help them to develop frequent hand hygiene habits as a part of daily hygienic lifestyle. It has been identified that there are five critical moments for handwashing in the daily life experience of an average individual. With this information, we have defined a range for the number of handwashing an average person is expected to attain in a period of one month. Our social game app will challenge users to meet one of our defined range of monthly handwashing count targets to earn rewards. Users will participate in our Handygienics challenge by capturing and sharing live videos of their daily hand hygiene or handwashing moments to submit entries for the challenge in order to meet the challenge target within the given period. A range of challenge will also be available for other hygienic practices like cleaning of latrines, for our users’ participation.

With this model, our solution will improve hygienic habit by employing the social media to engage people in activities that will gradually instill frequent hand hygiene practices into their daily lifestyles. Different challenge levels will be set up so that users can progress to meeting higher monthly hand hygiene targets as their participation on the social media platform progresses. The solution will promote compliance to hand hygiene and other hygienic practices as socially reputable lifestyle, which will be showcased and propagated on the social media by compliant participants. This approach to hygiene promotion and marketing will cause a gradual change in our target population from a lifestyle that attaches little importance to hygienic behaviour to a lifestyle that attaches much value to hygienic practices.

Our incentive system will also compensate users that successfully meet challenge targets with free health insurance benefits as motivation. Report by the World Health Organization and World Bank indicated that at least half of the world population cannot obtain essential health services. Similarly, millions of Nigerians lack access to essential healthcare services, with more than 90% lacking health insurance coverage. The National Health Insurance Scheme (NHIS) only covers 1.5% of the population in Nigerian since its establishment in 1999. Therefore, in addition to motivating people’s participation and facilitating change in hygienic behaviour, our reward system is also designed to address the problem of unequal access to effective healthcare through donor-funded health insurance.

Interventions to address sanitation and hygiene problems are known to commonly focus on the provision of facilities. Our solution follows the perspective that water and sanitation programs cannot prevent diseases and deaths if they operate in isolation of hygiene promotion. In the developing world, CLTS (community-led total sanitation), the primary strategy for sanitation and hygiene promotion, is tailored for applicability in the rural settings and has limited adaptability for urban settings. More so, common existing strategies for hygiene promotion are based on the creation of awareness through occasional contacts with the target populations. Our solution employs an approach that will engage our target population in live practice of frequent hygienic behaviour on the go.

Handygienics is designed to uniquely promote hygienic behaviour through the social media, one of the most effective channels to reach the modern urban population. By taking advantage of various social media activities, people of the modern society are able to achieve virtual reputations and status for themselves within the online community. Our solution will leverage this motive to drive improved personal hygienic behaviour in the urban population. In addition, our incentive system is designed to further reinforce compliance to hygienic practices. The reward system of health insurance bonuses for compliant participants will help us achieve a single multifaceted model that addresses two major health problems of our target population: disease prevention and equal access to healthcare.

Our solution is a mobile application designed for live video capture of the hand hygiene moments of users participating in our range of hand hygiene challenge. This will enable us to achieve a hygiene promotion system where our target population are able to make submissions of their hand hygiene practices on the go daily.

We will implement AI technology for content analytics of the video submissions from our numerous users in order to track compliance rate and improvement in hygienic practices effectively. We will implement features such as the Azure Cognitive Services to screen shared videos for our specific users and target hygienic activities.

Problem: Poor hygienic behaviour is common in the developing world, causing diseases and deaths

Changes: 

1. (1) People will value hygienic practices
2. (2) People will adopt frequent hand hygiene practice

Outcome: People will develop a hygienic lifestyle and prevent diseases

The core of our solution is that hygiene problems like poor hand hygiene in Nigeria and across the developing world stems from lifestyles that attach little value to hygienic behaviours, which has persisted for a long time. Hence, our solution also seeks to affect a change in overall hygienic lifestyle.

Social media has evolved into a powerful tool used in ways that have real impact on the modern society. A study by New York Times showed that top reasons that motivate people to share information on social media include the desire to reveal “valuable” contents to others; to participate and feel involved in things happening in the world; to project an image of self. Media contents such as images and videos shape our views of the world and deepest values. Therefore, modern societies constitute new cultures, lifestyles and trends through contents shared on social media. For instance, through social media, environmental campaigns have succeeded in changing the way people value climate change and environmental issues. Platforms like fashion and beauty blogs also create value for certain looks through social media contents, and are succeeding in shaping lifestyle trends such as the recent transition to “Diversity Ideal” from the “Thin Ideal”. Therefore, we aim to leverage similar tool to promote hygienic lifestyle.

Our solution is presently under prototype development and unable to serve anyone. Upon complete development, we aim to have our first launch in Lagos, the major urban hub of Nigeria. By the end of the first year after Handygienics is operational, we estimate that at least 1 million of the 67.5 million social media users in Nigeria would have engaged in the hand hygiene challenge of our platform. Through our activities during this time, we expect that hand hygiene will generally become a popular culture in urban Nigeria. We also expect that feedback from our users will indicate the rate of sicknesses and infections will reduce among users participating on our platform.

In five years’ time, we expect that the success of our initiative in Nigeria will provide entry for our solution into other countries in the developing region of the world, where poor hygienic culture is also a challenge affecting about 3 billion people in the urban areas. We project that by 2026, our platform would engage a minimum of 5 million active users participating on our platform.

In the first one year, we expect that our solution would have reached full product development, succeeded its pilot launch in Lagos, and be growing to influence improvement in hand hygiene compliance rate in at least 50% of our users across Nigeria, within and outside Lagos. It is also our goal to have contributed to accessibility to healthcare for about 500,000 Nigerians within the first year though our health insurance incentive system. With the number of users/participants on our platform as well as the impact rate, it is our goal to attract more donors and corporate partnerships to increase funding and sponsorship for our program within and after the first year.

Within the first five years, we plan to scale our solution into a platform where hygiene-sensitive institutions and enterprises such as those in the health sector, food industry, schools, etc. can also promote their hygiene compliance status on the platform for publicity. For instance, the 2018 National Outcomes Routine Mapping (NORM) survey conducted in Nigeria by the Federal Ministry of Water Resources, UNICEF and National Bureau of Statistics (NBS) reported that only 4.5 per cent of the health facilities have their latrine cleaned at least once daily. Our solution will provide a platform where such institutions, organisations and business enterprises can showcase their compliance to hygiene practices for business promotion. This will ultimately motivate similar organisations and businesses to improve on hygiene compliance as a new prominent front for business competitiveness.

• Number of users: our solution is designed for a large number of users in order to achieve maximal impact in hygiene promotion and also to develop a system that generates funding for sustainability by leveraging its large number of users for corporate partnerships and donors.
• Product development: we anticipate that our platform will frequently generate a large volume of media data from our numerous users, and this will require implementation of AI features for data analytics, which our solution will require from pilot launch stage.
• Scalability: our solution has a strong potential to scale internationally to serve populations in other parts of the world.
• Operational barrier: our model’s incentive system requires a capacity to reach our users across different geographical locations for delivery.

• Number of users: we plan to depend on word of mouth and volunteer social media influencers such as concerned celebrities to achieve visibility for our product.
• Product development: we aim to develop partnership with external AI developers for technical services and training for our team’s developer.
• Scalability: we aim to explore the opportunities available for networking through SOLVE for scaling of our solution to other countries.
• Operational barrier: we plan to partner with existing health insurance structures such as the NHIS in Nigeria, for effective delivery of our program’s incentive system.

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3 (full-time)

The inspiration for the development of our solution comes from Olaitan and Oyinkansola’s training as parasitologists with track records in public health research. Having trained under renowned epidemiologists like Prof. Uwem Ekpo who advocates for behavioural change as the most effective solution for disease prevention and has developed tools like the Schisto and LadderTM game based on this premise, we have equally been inspired to develop a solution to affect change on hygienic behaviour toward disease prevention. We have leveraged on this background, including our experiences in WASH-related and implementation science research for more than five years, to guide the development of our model. Akaniyene is the developer in our team and has the technical skills to implement our model into a mobile application.

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• Disability-adjusted life years (DALY) is used to measure the effectiveness of health interventions, with the cost of one DALY estimated to be about US$34,000-68,000. One DALY can be averted with each investment of just about US$3.35 in handwashing/hygiene promotion.
• Developing countries are estimated to incur an annual net cost of more than US$12 billion from diarrhoea and pneumonia alone. This is equivalent to a per capita cost of about US$1,500. Hence, our solution will help individuals in our target populations to each save about $1,500 annually by preventing diarrhoeal infections through improved hygiene. Hand hygiene alone prevents 80% of common infections. This implies that participants on our platform can save on the cost of managing common infection problems by 80%.
• Our solution for hygiene promotion, together with the benefits of access to healthcare through health insurance, will help users to achieve overall health improvement and increased productivity as the frequency of infection and illness reduce.
• The economic benefit of hand hygiene is not isolated to the developing world alone but also a benefit to high-income countries where other infections pose economic costs. Model estimates showed that 1% increase in hand hygiene compliance saves about US$40,000 in drug resistance-related healthcare costs per year.

Users will be charged zero subscription fees to sign up and participate on our platform. However, subscription to our platform will require users to follow our pages on popular social media platforms. Through our large number of users and social media followers, we aim to leverage our platform and social media pages as publicity channel for corporate organisations.

We aim to attract donations, grants and corporate partnerships through this approach in order to raise funds and other forms of sponsorship for our Handygienics initiative. It is our goal to build a self-sustaining system by attracting a large number of users through our reward system, and in turn, leverage our users capital to attract funding and partnerships from corporate organizations.

1. We apply to SOLVE because the prize funds will help us to complete the development of our solution to become fully operational.
2. The opportunity for visibility through Solve will also accelerate our collaboration with funders with interest in our solution for hygiene promotion.
3. The 12-month personalized support program will give us free access to technical experts and strategic advisors that will help us to refine the design of our solution for the best impacts. We are especially interested in mentorship that will help us to implement the AI technology for our solution.
4. Solve is an avenue to develop the partnerships we need to deploy and scale our solution. We aim to leverage connections with global health stakeholders and influencers within Solve community to facilitate smooth partnership development with relevant organisations such as NHIS in Nigeria. To scale across countries, the internationally diverse Solve community will help us to partner smoothly with the relevant organisations across different countries.

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1. Health insurance organisations with wide in-country coverage e.g. NHIS in Nigeria
2. Funders of WASH-related and hygiene programmes e.g. UNICEF
3. Corporate organisations with interest in social investment related to hygiene promotion e.g. Unilever

Our solution will be propelled by the implementation of AI-powered data analytics to process the large volume of videos that will be shared by our users to ensure our users are the ones featured in the videos they share and that specific target hygienic activities are the activities covered in the videos recorded. We aim to utilize AI technologies such as the range of features in the Azure Cognitive Services to achieve these features.

Our solution applies social media technology as a tool to improve hygienic lifestyle as a strategy for the prevention of infectious diseases with a focus on urban populations. We aim to build a social community of users participating in our range of Handygienics hygiene challenge. Through this community, we aim to advance a new lifestyle that attaches values to hygienic behaviour in the developing world. Our goal is to utilize this system of creating social value for hygienic lifestyle to advance a social advocacy for "Hygiene Ideal" in the developing world, similar to the creation of the "Thin Ideal" and "Diversity Ideal" in the fashion industry which were also promoted through media contents.

This prize fund will equip us with the initial fund to support our incentive system which will help us to attract participation of users and eventually achieve a large online social community that will sustain the system.