The SADC Hygiene Strategy: a unique opportunity to invest and accelerate hygiene progress in southern Africa

7 min read
Image: WaterAid/ Chileshe Chanda

The Southern African Development Community’s Hygiene Strategy is a big step towards much-needed hygiene improvements in the region. Shenard Mazengera, WaterAid’s Interim Regional Advocacy Manager, shares some perspectives on this important opportunity.

On 9 November 2021, Ministers of Health from the 16 members of the Southern African Development Community (SADC) approved the SADC Hygiene Strategy (PDF) at their meeting in Lilongwe, Malawi. This was a highly significant commitment to tackle health challenges posed by the region’s poor hygiene standards. The first of its kind for SADC, the strategy was developed with the support of WaterAid, UNICEF and other partners, and provides a unique opportunity for SADC to act and show leadership on hygiene on behalf of member states. It is also an invitation for donors, development banks and the private sector to invest in hygiene, with the many expected benefits including improvements in health outcomes, and improved productivity through increased school attendance among girls and through women spending less time collecting water.

The poor state of hygiene requires action

Poor hygiene practice is a major contributor to endemic and epidemic disease in Southern Africa. The SADC region continues to report recurrent diarrhoea, cholera, typhoid, Hepatitis E, amoebiasis and Ebola outbreaks. Handwashing access is very low, especially among rural populations – in some countries the rate is less than 25% in rural areas. Handwashing with soap is one of the most cost-effective interventions to prevent diarrhoeal diseases, reducing incidence by up to 48%. It can also reduce the incidence of acute respiratory diseases such as COVID-19 by 36% and contributes to reducing the top causes of under-five mortality.

The Hygiene Strategy also presents an opportunity for SADC because hygiene is an essential policy investment for managing COVID-19, and for tackling future epidemics and pandemics. To be prepared for these health emergencies, the Community and its member states must strengthen national systems that increase water, sanitation, and hygiene (WASH) service resilience.

The SADC Hygiene Strategy is a key instrument by which to encourage countries in the region to acknowledge and commit to addressing the poor state of hygiene. The strategy states that it will “secure strong leadership, commitment, and accountability in creating a culture of hygienic behaviour and practices across all levels of government and society”. This makes clear that member states are willing to act on current challenges; the strategy will help countries do so and contribute to achieving and tracking progress on Sustainable Development Goal 6. Civil society and other actors should use the commitment in this strategy to demand that it is translated into action.

Precious Nyirenda, a nurse, talking with expectant mothers about hygiene behaviour and using soap and hand sanitiser to help protect against Covid-19. Simango Rural Health Centre, Kazungula District, Zambia.
Precious Nyirenda, a nurse, talking with expectant mothers about hygiene behaviour and using soap and hand sanitiser to help protect against COVID-19. Simango Rural Health Centre, Kazungula District, Zambia.
Image: WaterAid/ Chileshe Chanda

The Hygiene Strategy will improve coordination for sustainable hygiene behaviour change

SADC's strategy seeks to create an enabling policy environment for hygiene services and practices. A 2018 WaterAid report highlighted the poor and incoherent policies and strategies holding back implementation of effective hygiene services in the region. With the strategy in place, SADC and member states have an opportunity to implement coordinated and concerted actions that effectively support hygiene behaviour change.

Member states are also encouraged to create an enabling policy environment to sustain people’s changed hygiene behaviours. The Hygiene Strategy provides the important political backing and push for change on how hygiene is addressed, and clear guidance to support the regional and national-level stakeholders implementing hygiene programmes.

The strategy also supports interventions on hygiene behaviour change, seeking to develop communities of practice bringing together diverse stakeholders to discuss innovations and best practice on expanding and sustaining access and hygiene behaviour change in various settings.

Women and girls will benefit from this increased attention to hygiene

Better provision and management of hygiene will result in better health, nutrition, opportunities and dignity for women and girls, who stand to benefit at higher rates and in unique ways from safe, reliable and sustainable WASH. Good WASH services free up time for education and employment, reduce vulnerability to gender-based violence, and increase privacy and dignity. Through these improvements, good services enhance the voices, agency and economic empowerment of women and girls.

Many organisations already promote gender-friendly interventions, including encouraging female-friendly toilets in schools and healthcare centres that include facilities for menstrual hygiene management. With the SADC Hygiene Strategy in place, demand from citizens will increase for governments do more to support these and other interventions that will benefit women and girls.

Rova and her best friend Fanantenana standing in front of the new sanitation block at their school in Analamanga region, Madagascar.
Rova and her best friend Fanantenana standing in front of the new sanitation block at their school in Analamanga region, Madagascar.
Image: WaterAid/ Ernest Randriarimalala

Hygiene is a good investment for Southern Africa

The cost of millions of people worldwide living with inadequate access to WASH services is enormous – 1.6 million lives are lost every year. The tragedy of this aside, no country can afford to lose human potential on this scale. Tangible benefits flow from the health effects of improved WASH services and time saved with better access to facilities. Investing in universal WASH could unlock trillions of dollars in growth over the next two decades. Increasing access to WASH services is not only the right thing to do, but represents a sound fiscal investment in the future, catalysing recovery from the COVID-19 pandemic, and building resilience to future health, climate, and economic shocks.

SADC has committed to develop sustainable financing mechanisms for hygiene through its strategy. Member states say they will improve financing for hygiene through both internal and external sources. This is significant because it creates opportunities for hygiene interventions in the region to be supported more sustainably.

There is a strong case for investment in WASH in healthcare facilities, especially given that hand hygiene is the first line of defence against the spread of infectious diseases. This is particularly important for respiratory illnesses, which can be reduced by up to 21% (PDF) when handwashing stations with soap and educational materials on hygiene practices are available. WASH in healthcare facilities can also prevent healthcare-acquired infections and the spread of antimicrobial resistance, and improve overall quality of care.

Yet in SADC countries there isn’t adequate budgetary allocation to hygiene or WASH, and WASH services compete with other priorities. The approval and implementation of the strategy supports the case for better financing of WASH, and gives donors, development banks and private players clear goals and strategic actions, laying out how hygiene will contribute to achieving the region’s goals.

Other stakeholders, including WaterAid, can use the strategy to show the urgent need to scale up hygiene – particularly hand hygiene – in healthcare facilities, schools, public places, and homes or communities to help control COVID-19 and reduce the risk of future pandemics, while improving health across all population groups, especially among the most vulnerable.

The future of hygiene in Southern Africa

The critical importance of the SADC Hygiene Strategy cannot be overstated – it plays a pivotal role in the development of the region and member states. Increased access to improved sanitation and hygiene facilities and services contributes to the health and wellbeing of populations, and improves gender and women’s rights, which, in turn, drives overall social and economic development. To ensure the strategy is adequately funded and implemented requires the individual and collaborative work of SADC member states, development partners and civil society organisations.

While the Hygiene Strategy is a key milestone, it is important that member states take steps to ensure the strategies and actions agreed are executed. SADC, through its secretariat, should create a clear rollout plan and benchmarks to monitor progress. We call on member states to keep their promise and invest in hygiene to make the strategy possible. Health ministers will be reminded of these commitments during their annual council meetings. Donors and development banks should substantially increase investments and mobilisation of resources to finance and sustain WASH services and infrastructure in the SADC region.

We will work with other partner organisations to share best practice and ideas, and to help monitor how member states are implementing the strategy. Civil society and NGOs should advocate that SADC and member states live up to their commitments, and empower citizens to understand the strategy and hold their governments to account. We will be questioning and asking for updates on SADC member states’ progress at every opportunity.

Shenard Mazengera is WaterAid's Interim Regional Advocacy Manager for Southern Africa.

Top image: Gloria and other hygiene club members washing their hands with soap at the handwashing bay in the newly constructed sanitary block at their school in Mecanhelas District, Mozambique.