Editor’s Note: This article written by WSSCC Carolien van der Voorden was originally published on The Guardian partner zone, 15 October 2016.
This Saturday, 15th October, is Global Handwashing Day. The day was brought into life in 2008 by the Public Private Partnership for Handwashing with Soap to call attention to a small behaviour with potentially huge consequences.
You see, 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 together responsible for killing 1.7 million children each year. Because of the lifesaving potential of handwashing with soap, hygiene promotion was recognised in 2008 as the most cost-effective health intervention by a wide range of health experts.
None of this was well-known, and so Global Handwashing Day was born and quickly became a big hit. In just a few years, it has grown into a worldwide event where literally hundreds of millions of school kids, health workers, politicians and ordinary people are drawn into celebrations, demonstrations, and promotions of this small, but vital behaviour.
Global Handwashing Day is important, and needs to be celebrated. Unfortunately, asking 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? How last nights’ dinner didn’t sit too well? What to wear today? 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 recently told you that you really need to start flossing as part of your daily dental hygiene routine. This isn’t something you were used to, and chances are you find it a pain, choose not to, or simply forget most of the time, even though you know it’s for your own good will. 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 one has ready access to a wash basin, running water and soap, and even more so in a situation where people have not.
In vast parts of Africa and Asia, where WSSCC, through its Global Sanitation Fund, supports sanitation and hygiene behaviour change programmes, people face a low availability of water, rudimentary facilities (often not more than a bucket and a small bowl out of which water is poured over hands, back into the bucket, therewith contaminating its entire contents), and a whole host of circumstances that make it unlikely for them 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 about the potential of using emotional drivers, such as disgust, affiliation (the desire to belong, to be respected) and the desire to nurture (especially strong in mothers, wanting to raise happy and healthy families); about the importance of and ways in which you can teach or nudge children into better handwashing habits in schools; and about the potential of certain low-cost handwashing facilities that could be marketed to a certain segment of low-income populations to make it easier for them to wash their hands.
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, it also showed that it could not be significantly matched with an actual change in handwashing behaviours linked to toileting 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 then requires many 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 on going, 365 days of the year. So take a minute today, as you ladle up your hands with soap, and think about this powerful habit and how lucky you are to have it.
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