National evaluation of hygiene promotion through routine immunisation

Overview

Rolled out nationally in 2020, the programme uses regular immunisation visits as trusted opportunities for health workers to engage mothers and caregivers on handwashing, food hygiene, safe water and milk treatment, breastfeeding, sanitation and the safe disposal of children’s faeces. Anweshan’s role was to examine how well this integration was working after five years, what had changed since the 2019/20 baseline and what would be required to sustain it within Nepal’s health system. The evaluation reached 40 municipalities across 10 districts and included surveys and structured household observations with 1,239 mothers and caregivers of children aged 16–23 months. It also assessed immunisation sessions and brought together evidence from health workers, Female Community Health Volunteers, government officials and development partners through interviews, focus-group discussions and stakeholder consultations at federal, provincial, district and municipal levels. Alongside examining hygiene knowledge, social norms and observed practices, the study assessed immunisation coverage, programme reach, delivery quality, health-worker capacity, enteric-disease trends and the additional cost of integrating hygiene promotion into routine services. The evaluation found that routine immunisation provides a practical, trusted and high-reach platform for reinforcing essential hygiene behaviours without compromising vaccination services. It documented important progress while also identifying gaps between knowledge and consistent practice, as well as operational challenges related to workload, materials, space and continued behaviour reinforcement. By combining community experience, service-delivery evidence, health-system analysis and programme costing, Anweshan produced a strong evidence base for WaterAid Nepal, government counterparts and partners to improve implementation, protect programme quality and make informed decisions about the long-term sustainability of this nationally significant initiative.

Expertise

How we worked

What it produced