Amplio impact:



According to the CDC, a number of challenges and barriers to good hygiene exist in lower income countries. The greatest of these challenges is the lack of clean water. However, even under circumstances where clean water is not available, evidence indicates that hygiene practices (for example, washing hands) using unsafe water are beneficial to reducing the spread of disease and are better than not washing at all.

The CDC reports that in addition to water, another hygiene challenge in lower-income countries is access to soap. Even when soap is available, it is typically used for laundry and bathing instead of for hand washing.

Only 19% of people across the world wash their hands with soap after defecating.


Amplio partnered with UNICEF and Arm to use Talking Books to reach 44,000 people in 49 communities in Ghana’s Upper West Region. Audio content deployed onto Talking Books in Dagaare, the local language, included the benefits of hand washing with soap.


  • 16-23% reduction in risk of acute respiratory infection
  • 50% reduction in pneumonia
  • Substantial reduction in neonatal infections
  • Up to 48% reduction in risk of endemic diarrhea
  • A reduction in school absenteeism by 43% days

We believe more progress could be made by addressing the lack of access to soap and running water, which remains a huge challenge for remote communities. A common response in user feedback and focus groups was that people working on farms do not have soap which acts as a barrier to washing hands at critical moments like “after defecating,” “before eating,” or “before feeding a child.”


Families are 50% more likely to wash hands with soap when using Talking Books. People who used the Talking Book mentioned using soap significantly more often than those who did not.


Users record feedback about the information they receive on the Talking Book using the built-in microphone. This feedback provides invaluable insights into the impact that Talking Book messages have in the community.

“Diarrhea was a problem. Through sanitation messages and more hand washing ithas improved.”

“I went to a funeral, there was a lady preparing cakes and I told her to wash the hands of a child before feeding the cake to the child.”

“We discuss the messages every time we meet. If I see someone not washing with soap and water, I advise them to do so before eating.”

“We encourage parents to have kids wash with soap and water before eating -they will develop this habit as a child if they start early.”


Removing the danger of diarrhea

Madam Diana lives with her husband and their two-year-old daughter in Tizza-Kan, a small community of 29 households in the Jirapa Municipality of the Upper West Region, Ghana. Prior to listening to UNICEF C4D health messages delivered via the Talking Book, Madam Diana says that she and her family were impacted by severe, long lasting diarrhea episodes.

By listening to audio lessons about healthy hygiene and sanitation practices, Madam Diana’s family has learned that hand washing with soap reduces infection and prevents diarrhea.

“I always listen to the Talking Book whenever it comes to my household. I like the messages on hand washing. I now wash my hands after cleaning a baby, and my household members wash their hands with soap before eating. Diarrhea was a common sickness, but not anymore.”


UNICEF reports that in Sub-Saharan Africa, as many as 220 million (23%) still practice open defecation, 300 million (31%) rely on unimproved sanitation facilities, and 172 million have limited sanitation services (18%). Apart from the inconvenience and discomfort associated with this, 99 million school days are lost yearly.

A World Bank study of 18 African countries shows that over $5 billion of their GDP is lost yearly due to lack of sanitation. A study by the World Bank in 2016 puts the estimate of the costs of meeting the SDGs for sanitation to be several billions of dollars.

The Amplio/UNICEF project also included information about the dangers of open defecation. The Open Defecation Episode included on Talking Books distributed to 44,000 people in 49 communities in Ghana’s Upper West Region registered 22,148 plays to completion followed by 8,766 plays to completion for How to Correctly Wash Your Hands.

The high number times these messages were listened to completion suggests there is a high possibility that the community will become conscious of contamination through open defecation. The hope is that they will, as a result, adopt measures to end open defecation. This assertion has been evident during community visits; recorded user feedback and was emphasized by community members participating in Community Dialogue sessions.


Building a latrine

Madam Mwining-gang Bobonyerepuo is a 48-year-old widow in the Upper West Region, Ghana. Until recently, Madam Mwining’s family engaged in open defecation like many other households in their community. But after listening to a Talking Book song about the dangers of open defecation, Madam Mwining became determined to build a latrine.

“I realized that we are harming ourselves when we engage in open defecation, so I saved money to build my own toilet. I believe this is the best way to keep my family healthy,” she says.

Many households in the community are now building latrines, but Madam Mwining-Gang is one of the first to complete her latrine. She’s already planning improvements.

“I hope to use some of my future VSLA savings to plaster the latrine and fit it with doors.”

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