Hand hygiene for all
A culture of hand hygiene must be fostered and made the mainstay in public health interventions beyond the pandemic
Since its launch in 2008, the Global Handwashing Day (GHD), 15 October, is celebrated as a world event dedicated to increasing awareness on the importance of hand hygiene, especially through handwashing with soap. The 2020 GHD theme – ‘Hand Hygiene for All’ – is a call to action led by WHO and UNICEF to make hand hygiene a reality for everyone everywhere.
The current Covid-19 pandemic has highlighted the critical role hand hygiene plays in disease transmission. It reminds us of the importance of the simple yet most effective intervention to stop the spread of any disease – handwashing with soap – and the need to take immediate action on hand hygiene across all public and private settings to respond and control the pandemic. A global culture of hand hygiene must be fostered and made the mainstay in public health interventions beyond the pandemic.
Easy Prevention
Leave aside Covid-19, pneumonia (15%), diarrhoea (8%) and malaria (5%) account for almost a third of global under-five child deaths. Majority of these diseases can be prevented by basic water, sanitation and hygiene interventions. Handwash with soap alone can protect about one out of every three young children who get sick with diarrhoea and one out of five young children with respiratory infections like pneumonia. In a nutshell, handwashing with soap can:
• Reduce diarrhoeal diseases by 30% to 48%;
• Reduce acute respiratory infections by 20%;
• Play an important role in reducing the transmission of outbreak-related pathogens such as cholera, Ebola, shigellosis, SARS and hepatitis E;
• Protect against healthcare-associated infections and reduces the spread of antimicrobial resistance; and
• Contribute to the reduction of Neglected Tropical Diseases.
Handwashing with soap works by interrupting the transmission of disease. Hands often act as vehicles that carry disease-causing germs from person to person, either through direct contact or indirectly via surfaces. Washing hands with soap is also a key to fighting the Covid-19 pandemic as it destroys the outer membrane of the virus and thereby inactivates it. Studies indicate that regular handwashing with soap can reduce the likelihood of Covid-19 infection by as much as 36%.
The guiding vision of Global Handwashing Day is to promote a local and global culture of handwashing with soap. Although people around the world wash their hands with water, few wash their hands with soap at the critical moments.
Automatic Behaviour
In many countries, the lack of soap is not seen as a significant barrier to handwashing, with the vast majority of even poor households having soap. However, laundry, bathing and washing dishes are often seen as the priority for soap use, not washing hands. Hence, the challenge we face is to transform handwashing with soap from an abstract proven intervention into an automatic behaviour performed in homes, schools and communities worldwide.
The global Sustainable Development Goals (SDGs) also recommends hand hygiene as a priority component in schools, healthcare facilities and at the household level. In India, too, hand hygiene is an important component of the Swachh Bharat Mission initiated in 2014.
Unfortunately, two out of five people in the world do not have a handwashing facility on premises. And almost half of the schools in the world do not have handwashing facilities with soap and water for students.
Indian Scenario
The picture is similar in India, with only about one-third of all Indian households using soap to wash hands before a meal and only three-fourth using soap for washing hands after defecation. As per the WHO and UNICEF Joint Monitoring Programme report on hygiene interventions, 542 million people in India live without a basic handwashing facility and around 41% schools in India have no hygiene services. Added to this, there are major challenges in promoting hand hygiene behaviours, including lack of education and understanding of hand hygiene, poor infrastructure and lack of cost-effective technologies for institutions and public places. This could be a big challenge in containing Covid-19.
Global Recommendations
Therefore, the ‘Hand Hygiene for All’ global initiative aims to implement WHO’s global recommendations on hand hygiene to prevent and control the Covid-19 pandemic and work to ensure lasting infrastructure and behaviour. It is designed around three stages: responding to the immediate pandemic, rebuilding infrastructure and services, and reimagining hand hygiene in society.
Handwashing behaviours naturally increase during outbreaks, but action is needed to ensure sustainable behaviour long-term. When people are suddenly flooded with information about a new pathogen and perceive that they are at risk, social norms like hand hygiene change to adapt to the pandemic. Unfortunately, the effect of outbreaks on hygiene behaviour is short-lived. As fear subsides or if the outbreak becomes endemic and normalised, hygiene behaviour will decline too. The key role of governments and response agencies is to enable sustained access to handwashing facilities and motivate practice by positioning it as the right thing to do and continue beyond the pandemic.
In India, in particular, the Central and State governments need to implement focused action specifically on hand hygiene. This includes, first of all, improving the access to sustainable hand hygiene services (handwashing facilities, regular water supply, soap or alcohol-based hand rub) at household level, institutions and public places. Secondly, initiating effective behaviour change interventions promoting handwash by developing targeted communication strategies. Thirdly, capacity building interventions across all levels to inculcate the habit of hand hygiene among all. And lastly, effective policies for coordination mechanism, financing through different line departments, Central and State funds.
But it is important to remember that no single actor or agency can make hand hygiene for all a reality by themselves. ‘Hand Hygiene for All’ is a call for coordination and collaboration across sectors. The Covid-19 pandemic has shown that preventing the spread of infectious diseases is not just the task of the Ministry of Health. To keep everyone healthy, everyone has a role to play. For hand hygiene, this ranges from employers and school principals, to innovators and government ministries, to communities themselves.
(The author is Chief of Field Office, UNICEF Office for Andhra Pradesh, Telangana & Karnataka)
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