Health and hygiene behaviour change: bottom-up meets top-down in Tibet

The Tibet Poverty Alleviation Fund (TPAF) has been working in the Tibet Autonomous Region of the People's Republic of China since 1998 to increase the income and assets of rural Tibetans. From the beginning, TPAF recognised that high morbidity and mortality were a constraint on efforts of rural Tibetans to improve livelihoods. Early interventions to train township doctors and midwives were not sustainable. In 2005, in partnership with local health authorities, TPAF launched a Behaviour Change Communication (BCC) strategy to build villagers' capacity to improve health and hygiene practices and to make informed choices about using government-run primary and preventive health services. Results from counties and townships in three Prefectures are preliminary, but they show significant changes in health knowledge and practice, and growing links between village needs and government services. Next steps include strengthening implementation and institutionalising government support to extend and support the approach.