Hygiene in Practice (HIP) employed an at-scale approach in Ethiopia's Amhara Region, predicated upon the principle of multiples. The project promoted improved hygiene behavior by working on multiple levels, engaging multiple players, and stressing multiple behaviors through multiple interventions. HIP used Hygiene Improvement Framework to focus on three elements that catalyze and sustain hygiene and sanitation improvement: (1) Access to hardware; (2) Access to an enabling environment that includes facilitating policy platforms and competent institutions; and, (3) behavior change.