By Clemens Gros, M&E Specialist and Innovations Lead, UNICEF Ghana

In 2015 alone, over 10,000 children under five in Ghana died from pneumonia and diarrhoeal diseases (WHO 2015). Therefore, one year ago we set out to develop a serious game that could teach children in Ghana about the importance of handwashing. 

Handwashing with water and soap (HWWS) is proven to be the most cost effective health intervention to reduce both the incidence of diarrhoea and pneumonia for children under five years. However, less than 1 in 8 Ghanaian households practice HWWS.

Why use games to teach handwashing, and how to do it?

Children playing Handwashing with Ananse
Children cheering each other on while playing Handwashing with Ananse, Akosombo, Southern Ghana. © Climate Centre/2016/Steenbergen

Evidence on information campaigns to promote handwashing in other countries has shown that these interventions often lead to higher awareness in the short term but show limited longer term impact in terms of actual behaviour change. A growing body of research suggests that experiential learning through play can be effective in transferring knowledge and inducing behaviour change.

UNICEF Ghana has therefore partnered with the Ghana Education Service, Red Cross/Red Crescent Climate Centre, Engagement Lab at Emerson College, Right to Play and Ghana Red Cross to develop a set of highly engaging, interactive stories and offline games that teach children why, how and when to wash hands with water and soap.

Following a user-centred, iterative design process, a wide range of game prototypes was tested and further refined with feedback from over 600 school children in Ghanaian primary schools.

Handwashing_with_Ananse_CoverImage
Handwashing with Ananse: The game has been developed around a widely known Ghanaian folklore character who resembles a tricky spider. In one famous story he steals all the world’s knowledge and hides it in a pot. When the pot breaks the knowledge goes back into the world, but in this game he manages to grab the handwashing knowledge and shoves it in his pockets. The children must win the knowledge back from him to stay healthy. © Engagement Lab/2016/Kimbrough

The final product – a modular game embedded in local folklore and culture

The development was finalized in April 2016. ‘Handwashing with Ananse’ is now a three-chapter story and game experience centered on the popular Ghanaian folklore character Ananse. He often takes the form of a spider who likes to trick other people.

In our game, Ananse has stolen all the knowledge about handwashing and hid it in his pockets. The children have to play through three scenarios where they trick Ananse to win the handwashing knowledge back from him. The three chapters in the facilitation guide are illustrated with Ghanaian artwork and focus on distinct pieces of knowledge: why it is important to wash hands with water and soap; how to do it correctly; and when to do it.

‘Handwashing with Ananse’ includes so-called engagement activities that encourage children to teach others, their peers, family and community members, about what they learned during the games.

All materials freely available to download, ready for roll-out

The facilitation materials have been made available for free under the Creative Commons 4.0 License. The colourful guidebook, also available as laminated facilitators’ guide from UNICEF Ghana, can be downloaded here (PDF, 5 MB). We are currently finalizing short tutorial videos and additional resources for facilitators which will be accessible on the UNICEF Ghana website.

The game is entirely ‘offline’ and playable with locally available materials in any part of the world.

Facilitators playing Handwashing with Ananse
Facilitators playing Handwashing with Ananse at the training of trainers in Akosombo, Southern Ghana. © UNICEF Ghana/2016/Gros

A training-of-trainers was organized for UNICEF’s partners in March 2016 in Ghana. The rollout of ‘Handwashing with Ananse’ has now begun. Ghana Education Service has piloted the games in 160 public schools in the Komenda-Edina-Eguafo-Abirem district in Ghana’s central region. 960 student peer educators were trained and have facilitated the games with about 16,000 school children. Ghana Red Cross plans to cover 6 regions over the coming two years, and Right to Play will implement it in over 50 districts, both with UNICEF’s support.

Participants at the training of trainers for Handwashing with Ananse in Akosombo, Southern Ghana, March 2016.
Participants at the training of trainers for Handwashing with Ananse in Akosombo, Southern Ghana, March 2016. © UNICEF Ghana/2016/Gros

An innovative evaluation to assess the game’s effectiveness

‘Handwashing with Ananse’ will now be subject to a rigorous quasi-experimental evaluation. It will asses the effectiveness of the games in transferring knowledge and leading to increased handwashing behaviour in the medium term. More details will be provided in a separate blog post that describes the innovative sensor technology used in the evaluation.

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