The future is in our hands: Global Handwashing Day 2021

Last week, on the 15th October, it was Global Handwashing day. This day was designed to promote proper sanitation practices and to increase awareness of handwashing as a preventative measure of illness and disease, where it acts as a tool to remove barriers to education, economic opportunity and equity. 

"It’s simple. It’s right there and doesn’t cost anything"

Miryam Wahrman

In this post, I will outline how promoting handwashing as a mechanism to prevent disease and illness, is not quite as simple as biologist: Miryam Wahrman (William Patterson University of New Jersey), framed it in a 2020 Guardian article, where in reality, there a lot of different facets to the faucet... 

  

The "father of handwashing", Dr Semmelweis discovered the importance of handwashing over 150 years ago, and even though we have had this knowledge for over a century, handwashing still remains severely neglected as a public health investment. In West Africa, as shown in the figure below, the majority of people do not have basic handwashing facilities at home.

Figure 1: Proportion of population with no handwashing facility at home (2017)

So... it isn't just right there?

Access to handwashing facilities are limited, and even where the infrastructure is in place, it is often unaffordable, unreliable and inaccessible, limiting the opportunity for effective handwashing. 

A large proportion of the population in West Africa have to fetch water from great distances, multiple times a day, from unprotected sources. However, two thirds of the relatively fortunate households who do have piped water systems, receive water intermittently and inconsistently. This case is particularly exaggerated in dry seasons where the availability decreases further, and as a consequence any available water is then stored and saved, where it is extremely difficult in these conditions to wash thoroughly, and practice effective hygiene measures. 

So.... it does cost something?

Even were there is reliable water infrastructure, the water has to be affordable for frequent handwashing to take place. Many cash-poor households have become acutely conscious of the cost of their water use, and as a consequence, handwashing occurs sparingly. 

Many hands make light work: the toolkit for hygiene advocacy 

Handwashing behaviour is notoriously hard to change. Partnerships with organisations as well as collaborations between sectors, can help to strengthen advocacy and ensure a meaningful change is implemented. As highlighted above, provision of health knowledge alone is insufficient, where it is vital to also invest in convenient and accessible hygiene infrastructures and products to ensure that handwashing facilities are "right there", available and accessible to all. 

The Global Handwashing Partnership (GHP) is a coalition that unifies expertise, experience, ideas, resources and reach of public and private sectors, where the key descriptors of successful hygiene advocacy are highlighted as: target and action-orientated, deliberate, evidence-based and collaborative. 

Advocates have an important role to play in pushing for this sustained investment in order to ensure availability and effective management of of water for all. According to the GHP toolkit, advocates should focus on developing strategies and budgets with all levels of government to allocate resources for monitoring outputs and results.

 

COVID 19 and Handwashing

Figure 2: "Wash Coronavirus Away" Poster 

Handwashing came to the forefront of discussions again during the pandemic, as it has the potential to interrupt several routes of COVID-19 transmission. At a time where something as "simple" as handwashing became the foundation for survival, it highlighted the importance to ensure that there are investments made into this provision in the long-term. 

So as many of us stood at our sinks washing our hands to the second round of the 'Happy Birthday song', did we stop to question that being able to access handwashing facilities in the home is luxury?