This Saturday, 15 October, is Global Handwashing Day. The day was brought into life in 2008 by the Global Public-Private Partnership for Handwashing with Soap to call attention to a small behaviour with potentially huge consequences.
Washing hands with water and soap, or ash if you have to, has been recognised as a highly effective behaviour to reduce a whole slew of diseases – most notably diarrhoea and respiratory illnesses which are jointly responsible for the deaths of 1.7 million children each year. Due to the life-saving potential of handwashing with soap, hygiene promotion was recognised as the most cost-effective health intervention by a wide range of health experts in 2008.
None of this was well-known previously and so Global Handwashing Day was created and quickly became a big hit. In just a few years, it has grown into a worldwide event where hundreds of millions of schoolchildren, health workers, politicians and others celebrate, demonstrate about, and promote this small, but vital behaviour.
Global Handwashing Day is important and needs to be celebrated. Unfortunately, asking for attention for a cause does not a habit make.
What did you think of when you woke up this morning? Your plans for the day? What to wear? The chances are that while you were thinking of these things, you got out of bed and started performing a whole set of actions without even thinking of them; splashing water on your face, brushing your teeth, going to the toilet, washing your hands, or having a shower – things you do every day that have become so habitual you do not even think of them anymore. They are largely dependent on your environment and on the time of the day, and are often done in the same sequence - they’re what you always do.
Now imagine that your dentist has told you that you need to start flossing as part of your daily dental hygiene routine. This isn’t something you were used to, and chances are that you find it a pain, choose not to do it, or simply forget most of the time – even though you know it’s for your own good. It would be similar if you had been advised to start washing your hands at a time you were not previously used to.
Handwashing behaviours are notoriously hard to change and to sustain. That is true in a situation where someone has access to a wash basin, running water and soap, and even more so in a situation where people do not.
In vast parts of Africa and Asia, where WSSCC supports sanitation and hygiene behaviour change programmes through its Global Sanitation Fund (GSF), people face a low availability of water, rudimentary facilities (often no more than a bucket and a small bowl), and a whole host of circumstances that make it difficult to develop a solid handwashing habit.
Even when people know the importance of washing hands, even when they do it some of the time, they are unlikely to do it at all of the critical times that scientists have identified as key for health impact: after using a toilet or cleaning babies’ bottoms, and before handling food.
We have learned some things about effective handwashing promotion, for example, the potential of using emotional drivers, (such as disgust, affiliation and the desire to nurture) , the importance of nudging children into better handwashing habits in schools and ways to do this, and the potential of low-cost handwashing facilities that could be marketed to certain low-income populations.
But there is no silver bullet, and for every successful handwashing promotion intervention there are as many unsuccessful ones - if not more. A forthcoming study from Nigeria with the London School of Hygiene and Tropical Medicine will soon reveal some of these inconsistencies. The study shows that when a handwashing promotion component was added onto ongoing community-led total sanitation activities, this did indeed result in an increase in the number of households constructing handwashing facilities close to their toilets. However, the study also showed that it could not be significantly matched with an actual change in handwashing behaviours linked to toilet events or food handling. The study was conducted in a GSF-supported collective sanitation and hygiene behaviour change programme, and based on extensive formative research and iterative testing of intervention components.
This result requires handwashing programmes to go back to the drawing board and try again. The cause is worthy of it, and the potential impact compels us to keep going. So take a minute today, as you lather your hands with soap, and think about this powerful habit and how lucky you are to have it.
Content on this page is paid for and provided by WSSCC, a sponsor of the Guardian Global Development Professionals Network
