Handwashing, also known as hand hygiene, is the act of cleaning hands for the purpose of
removing soil, dirt, and microorganisms. Although it can prevent infection and save lives, good hand
hygiene is not widespread in domestic, school and healthcare settings. Only 19% of people across the
world wash their hands with soap after defecating. 35% of healthcare facilities have no water and
soap for handwashing, and only 21% of schools in developing countries have handwashing facilities.
Furthermore, compliance with handwashing behaviours are worse in many low-income settings.
UNICEF data show that nearly 900 million children have either limited or no handwashing service
at their school. 47% of schools worldwide do not have handwashing facilities with soap and water. ½
of schools in the least developed countries have no hygiene service at all.
Why is handwashing with soap important? few data…
Water alone does not dislodge dirt, grease, and the natural oils on hands, but soap helps break down
germ-carrying oils. Soap also facilitates rubbing and friction which can remove germs from the
hands, and so that germs can be rinsed away with water. Using soap also adds to the time spent
washing and ensures a more effective wash. With proper use, all soaps are equally effective at
removing germs that cause disease. Moreover:
• Washing hands with soap at critical times (after using the toilet, before eating and preparing food)
can reduce diarrhoea rates by more than 40%. Handwashing with soap is one of the most costeffective
interventions to prevent diarrhoea-related deaths and disease.
• Handwashing with soap can reduce the incidence of acute respiratory infections (ARIs) by more
than 20%.
• Up to 50% of cases of malnutrition are caused by inadequate water, sanitation and hygiene.
• Handwashing promotion in schools can play a role in reducing the number of days children miss
school. Studies reveal that promotion and distribution of soap in primary schools result in more
than 50% fewer days of absence among students compared to schools without such an
intervention.
• Health costs due to hygiene-related diseases can be reduced by good hygiene habits such as
handwashing with soap.
How can we change people’s hand washing behaviors?
Access to clean water and soap alone will not deliver the health and development benefits of
handwashing. It is true behavior change and the sustained and consistent practice of the new
behavior that ensures the positive results. Changing people’s behavior is difficult and complex, but
possible with the right approach and in the right context. Behavior change is not a rocket science, nor
a silver bullet; it is a social science and it requires a multi-disciplinary approach in order to design,
implement and evaluate programs more effectively. A collective effort from governments, donor
agencies, I/NGOs, local capacity based organizations (CBO), private sector, academia and civil
society is urgently needed in the sector to implement and evaluate sustainable handwashing
campaigns at scale.
In India, for example, the Mid-Day Meal which is a government flagship program operational in all
schools across the country serves nearly 110 million children in 1.3 million primary and upper
primary schools . It provides an excellent opportunity to influence hygiene practices of children
particularly handwashing with soap before meals. Learning this simple, but lifesaving habit in school,
also means that children can inculcate this among other household members too. As powerful agents
of behavioral change, children can take lessons they have learned at school back home to teach their
parents, siblings and elders on good hygiene behaviors such as handwashing with soap. It is a path
breaking innovation that can potentially improves the education and health outcomes of 110 million
children who have mid-day meal daily, across the country. Group Handwashing ensured that all
children wash hands in ‘groups’, stand facing each other, exchanges positive messages, make ‘eye to
eye’ contact and enjoy the process. Making this happen on an every-day basis before Mid-Day Meal
in every school of the country, leads to a new ‘social norm’ around handwashing before meals.
Global Handwashing Day and the international commitment:
Global Handwashing Day (October 15th) was established in 2008 as a platform to advocate for
greater attention to hand hygiene. This effort, combined with many other efforts to bring attention to
the need for improved water supply, sanitation, and hygiene, have resulted in the inclusion of
handwashing as an indicator within the Sustainable Development Goals (specifically, 6.2.1). With
this, more countries than ever before have begun to include handwashing with soap as an indicator in
their routine data collection.
Target 6.2 of the Sustainable Development Goals (SDGs) calls on the global community to achieve
access to adequate and equitable sanitation and hygiene for all by 2030. Despite this, hygiene still gets
low levels of political attention in low and middle-income countries. One explanation for this is that
historically, the WASH (water, sanitation and hygiene) sector focused on building taps and toilets,
whilst the healthcare sector focused on treating patients and behaviour change has always been seen
as a difficult undertaking. Target 6.2 indicators for handwashing include the ‘proportion of
populations with handwashing facilities with soap and water at home’. However, this indicator is just
a proxy measurement, and doesn’t tell us whether people are actually practicing handwashing. There
is therefore a need for each country to set up a behavioural outcomes-related indicator in addition to
target 6.2. Though there is growing recognition of the importance of behaviour change it is still
highly neglected. The biggest challenge in the WASH sector right now is how to achieve sustained
hygiene behaviour change at scale, and attain Global Goal 6 (clean water and sanitation for all).
Our commitment:
HEEALS (Health, Education, Environment And Livelihood Society) is one of those organizations
directly involved in implementing hand washing with soap in children’s daily routine. It is working on
WASH (water, sanitation and Hygiene) projects in seven states: Delhi (National Capital Region),
Haryana, Rajasthan, Himachal, Uttranchal, Leh and Uttar Pradesh. HEEALS works in slum
schools, schools in unauthorised colonies, orphanages and refugee camps. Through spreading
education on sanitation and personal hygiene and delivering basic hand washing material, HEEALS
is working to increase the attendance rates of pupils in schools, reduce the number of diseases and
deaths and improve the health of people across Indian society.
-Manuel
WASH Intern
References:
- Curtis V, Kanki B, Cousens S, Sanou A, Diallo I, Mertens T. Dirt and diarrhoea: Formative research in hygiene
promotion programme. Oxford University Press 1997; (12(2)): 122-31.
- Freeman M, Stocks M, Cumming O, Jeandron A, Higgins J, Wolf J, et al. Hygiene and health: systematic review of
handwashing practices worldwide and update of health effects. Tropical Medicine and International Health. 2014; 19(9):
906-16.
- WHO, UNICEF. Water, sanitation and hygiene in health care facilities: Status in low- and middle-income countries and
way forward; 2015.
Links:
https://globalhandwashing.org/handwashing-with-soap-why-should-we-care/
https://washdata.org/reports
http://unicef.in/story/129/fast-facts-and-figures-about-handwashing
https://globalhandwashing.org/about-handwashing/faqs/
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