Using Testimonials to Drive Action: A Story of Hygiene Promotion in Liberia

“Hygiene is an important issue due to the burden of disease in Liberia,” says Amos Gborie, Director of the Division of Environmental and Occupational Health, National Public Health Institute of Liberia (NPHIL). To promote good hygiene in Liberia, NPHIL, with support from Breakthrough ACTION and its partners, launched the Hygiene for Health campaign in 2022. The awareness campaign aims to accelerate progress towards equitable and inclusive access to good hygiene services in all settings. But knowing is different from doing. How can greater awareness at the national level lead to sustained healthy hygiene behaviors in districts, communities, and households?

Bridging the National and Subnational Disconnect

To transition from building awareness through the campaign to creating action at the local level, Breakthrough ACTION Liberia and NPHIL tapped into a network of existing influential leaders who can hold communities accountable to improving hygiene. First, Breakthrough ACTION worked with subnational health teams to identify local government authorities who support hygiene activities. It found a diverse group of 600 people, including country water, sanitation, and hygiene (WASH) coordinators; hospital administrators; district health officers; town chiefs; and community leaders.

Collaboration was key for identifying influential leaders and developing training content. Lindsey Leslie, Social and Behavior Change Advisor, Breakthrough ACTION Liberia, says, “The entire process was a collective effort between NPHIL, the Ministry of Health and other hygiene partners, so the training reached local authorities across the subnational level.” Content design also had to appeal to intended audiences. As Leslie states, “We met to co-create the testimonials, ensuring each one reflected language, key concerns, motivators, and other elements that would resonate with local actors.”

Next, Breakthrough ACTION developed and pilot a remote training course used testimonials to inspire action among these leaders. The script for each lesson simulated the advocacy, actions, and strategies needed to improve hygiene outcomes, including appropriate handwashing practices, food hygiene practices, and maintenance of hand pumps and latrines.

Because participants were spread across 12 of Liberia’s 15 counties and had different levels of internet access, Breakthrough ACTION delivered course materials using interactive voice response technology by Viamo, which only requires access to basic mobile phones.

Using Storytelling to Convey Facts and Inspire Action

Influential leaders found the lessons informative, engaging, and easy to understand, which increased the likelihood they will use them. During the endline survey, 90% of the leaders surveyed felt the remote training was useful for their work.

Even leaders who were initially skeptical about the training quickly came to see its merits. “My initial reaction was that [the training] was seen as a burden and time-consuming, but, as time went by, it was […] very educative,” says Jacob Z. Siaway, Environmental Health Coordinator, County Health Team, Margibi County.

Watta T. Sirleaf, District Health Officer, Mamba Kaba District, oversees her local health facility in Margibi County. She had been concerned about her facility’s broken hand pump and grass and brush around the facility compound that made cleaning the facility hard. “I applied the lessons by ensuring my facility staff constantly cleaned around the health facility, repaired the damaged hand pump, and ensured safe drinking water is available,” says Sirleaf.

Siaway felt similarly. “I was motivated to apply the lessons in my facility after I understood the importance of hygiene interventions. I [… made] it practical to ensure that facility infrastructures are properly cleaned and maintained at all times.”

Because each lesson used compelling characters to illustrate a particular set of hygiene-related behaviors, leaders could draw on the lessons most relevant to their work. Breakthrough ACTION regional field manager, Moses Shilue, also praised the quality of the lessons: “Lessons were easy, clear, and concise.”

In his role, Shilue encouraged the influential leaders across his region (covering five counties) to access the training and apply the lessons. He described previous efforts to improve hygiene, noting, “I had been conducting remote and in-person capacity building for key stakeholders at the county-, facility-, and community-levels.” However, from the continued engagement before, during, and after the training, Shilue believes the knowledge gained strengthened his peers’ capacity to be agents of change. “Facility staff are now reinforcing WASH and hygiene activity across their various facilities through clean-up campaigns, handwashing, and providing safe drinking water.”

Supporting Locally-Led Efforts and the Way Forward

Influential leaders like Sirleaf and Siaway are already using what they learned in their communities. Now, they hope to see such efforts expanded and sustained and believe supporting local initiatives is the way forward.

“Ownership in health interventions is key to supporting local action that could be beneficial to […] locals,” says Siaway. Shilue similarly believes that supporting local efforts helps “make WASH services accessible, available, [and] affordable,” while promoting ownership and sustainability.

Leslie believes the pilot was an efficient use of project resources. “Delivering the training via interactive voice response technology enabled influential leaders across Liberia to access the lessons at the touch of a button. By creatively using our resources, we reached remote areas and observed improvements in hygiene across many communities.”

With informed, influential leaders like Sirleaf and Siaway, sustained healthy hygiene behaviors—and thus a healthier Liberia—are becoming reality.

Written by: Meei Child, Communications Officer, Breakthrough ACTION, and Lindsey Leslie, Social and Behavior Change Advisor, Breakthrough ACTION Liberia