Global Handwashing Day: a chance to seize political will and fund hand hygiene for all

On Global Handwashing Day, Dr Om Prasad Gautam highlights why governments must lead and own efforts to increase funding for hand hygiene, and ensure that everyone, everywhere has somewhere to wash their hands by 2030.

Around the world, the COVID-19 pandemic heightened the need for everyone to wash their hands with soap and water more thoroughly, and more often. The fear of becoming unwell encouraged people to wash their hands at the beginning of the pandemic. Experience tells us, though, that this may be a temporary phenomenon. It’s all too easy for people to fall out of the habit of certain behaviours once the immediate risk has passed.

But washing hands with soap and water not only helps prevent the spread of infections and disease, but provides societal and economic gains, too. Healthy children are less likely to miss school, and healthy adults can still go to work. They don’t lose out on income, and businesses don’t lose productivity through employee sickness. This is why any efforts to encourage hand hygiene must use a variety of emotions, beyond fear, to make sure handwashing becomes part of daily life for everyone.

Global Handwashing Day is not only a reminder of the importance of handwashing. It also provides the opportunity to work with and influence governments and others to design, finance and put in place creative ways to encourage handwashing. This year’s theme: “Our Future is at Hand – Let’s Move Forward Together”,  reminds us of the unprecedented time we all live in and urges everyone to not only make hand hygiene a fundamental component of health and safety, but also to work together to change people’s hygiene behaviours for a generation, and on a massive scale.

A cost-effective intervention

During the COVID-19 pandemic, 3 in 10 people worldwide could not wash their hands with soap and water at home. Still today, medical staff in 43% of healthcare facilities cannot wash their hands before providing care. Similarly, 47% of schools in developing countries don’t have handwashing facilities, meaning that 900 million students worldwide have nowhere to wash their hands while at school. There are also huge disparities between low- and high-income countries, and between urban and rural areas. For everyone to be able to wash their hands at home by 2030, one of the UN’s Sustainable Development Goals, governments need to make progress at least four times faster.

Accelerating progress would provide so many benefits. Handwashing with soap can reduce:

• acute respiratory infections by up to 23%
• the risk of endemic diarrhoea by 30–48%
• the personal risk of seasonal colds and flu by 36%
• infant deaths caused by infections by 27%
• the risk of pneumonia by up to 50%
• missed school days by 43%

Handwashing is also one of the most cheapest ways to improve public health, costing just US$3 per disability-adjusted life year. Investing in programmes that promote handwashing with soap can also bring large economic gains. In India, for example, funding such programmes could see a $5.6 billion net return. WaterAid’s own research found that universal access to clean water and soap would reduce disease outbreaks by up to 20%, and could save more than $2.6 trillion in health costs between now and 2040.

However, the latest estimates show that providing handwashing facilities for everyone, everywhere will not be cheap. Between US$12.2 billion and $15.3 billion is needed over the next 10 years for everyone in the 46 least developed countries to have somewhere to wash their hands with soap and water at home. Between $4.9 and $6.6 billion of that cost is needed to promote hygiene behaviour changes, while the rest is needed for facilities and supplies, such as soap, taps and sinks, and water. The money needed to maintain handwashing facilities will only contribute to these costs.

These are huge sums of money, but funding hand hygiene facilities and promotion is a ‘no regrets’ investment that will prevent and control infectious diseases, reduce healthcare costs in the long-run, and help countries build resilient communities, and stronger health systems and economies. Governments must not wait for another pandemic to prioritise hand hygiene and should urgently develop fully costed national hygiene strategies.

WaterAid’s response to COVID-19

WaterAid has played a vital role in preventing the spread of COVID-19, by championing transformative hygiene behaviour change programmes. We promoted key hygiene behaviours – such as washing hands with soap, wearing a mask in public places and maintaining physical distance – to help reduce the spread in the 26 countries where we work. Our response was designed to expose people, multiple times, to visual cues and nudges to improve their hygiene behaviours. We reached 181 million people, distributed 1.8 million hygiene products (soaps and sanitisers) and installed 2,700 large-scale handwashing facilities in key public places.

Find out more about how WaterAid responded to COVID-19 in our learning documents, technical guide, expert blogs and in the video below.

Through our hygiene behaviour change programme, including our COVID-19 response, we have learned several lessons which, we believe, any programmatic response on hand hygiene should focus on in the future.

• Address multiple behaviours through the same programme to reduce the spread of infections. Diseases can be transmitted in many ways, so addressing only one behaviour will not stem the spread. To respond to COVID-19, for example, we promoted several hygiene behaviours such as washing hands with soap, wearing a mask in public places and maintaining physical distance. But equally, don’t ask people to do too much, too soon. Instead, focus on three key behaviour changes to achieve lasting change.
• Design evidence-based, context-specific, emotional and attractive programmes to encourage people to change their hygiene habits.
• Aim to reach people many times. People do not tend to change their habits after seeing a hygiene interventin once. Campaigns should use different assets in different ways to reinforce good hygiene. This will also reduce the likelihood of campaign fatigue.
• Use an equality and inclusion framework to make sure any hygiene campaign is inclusive from the beginning.
• Tap into existing large-scale delivery programmes to integrate hygiene into WASH, health, education, nutrition programmes where possible. It is particularly important to integrate hygiene into any vaccination programmes to ensure they are effective.
• Complement mass media efforts with community-based behaviour change promotions to make campaigns stronger and make sure hygiene habits become part of daily life.

What’s next?

We urge national governments to improve hand hygiene by developing and putting in place costed national hand hygiene strategies and ensure they are funded by strengthening budget monitoring and tracking hygiene spending across sectors.

We call on donors to urgently increase funding in hand hygiene programmes as a critical and ongoing element of preparing for and responding to pandemics, particularly in low- and middle-income countries. Donor governments must also make hand hygiene a measurable component of investments in WASH, health and education.

And we encourage fellow NGOs to prioritise hand hygiene programmes and support governments to make sure that handwashing facilities are put in place at scale, and that no one is excluded from robust hygiene behaviour change programmes.

Achieving the global goal on hand hygiene requires substantial planning and investment, not only for physical handwashing facilities, but for creative behaviour change programmes. Governments must lead and own this process – in partnership with NGOs, civil society organisations and the private sector – so that hand hygiene is integral to any development agenda, including efforts to respond to COVID-19 and prevent future pandemics. Without these efforts, the funding needed may not be secured and we may lose the political momentum and prioritisation gained during the pandemic.

Om Prasad Gautam is WaterAid’s Senior WASH Manager – Hygiene