The Water and Sanitation Program's(WSP) Global scaling up handwashing project is testingwhether innovative promotional approaches to behavior changecan generate widespread and sustained improvements inhousehold hygiene and sanitation practices in Peru, Senegal,Tanzania, and Vietnam. The purpose of this study was todocument the process through which tippy-taps were promotedto qualitatively explore the results and to draw out lessonsfor future interventions. Handwashing with soap at key timesis believed to be an effective and highly cost effectivemeans of reducing diarrhea incidence. However, global ratesof handwashing with soap are frequently low, particularlyamong the poor, who also face the greatest threat frominfectious diseases. Access to a convenient handwashingstation has been found to be associated with higher rates ofhandwashing and decreased fingertip contamination.Tippy-taps were an acceptable means of providing a low costenabling technology for handwashing in this population.Anecdotally they have increased rates of handwashing afterlatrine use. However, uptake appeared driven by the'push' of the intervention rather than the'pull' of the technology and the extent to whichspontaneous uptake and sustained use can be achieved in theabsence of intensive intervention activities is not known.Respondents in non model villages had little contact withmodel villages and were largely unaware of the tippy-tap.The interventions were labor intensive and probablydifficult to scale-up.
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