By David Shimkus Programme Director, Global Sanitation Fund
David Shimkus is Programme Director of the Water Supply and Sanitation Collaborative Council’s Global Sanitation Fund (GSF), hosted by the United Nations Office for Project Services. David has over twenty years of experience in international development and global health programming. Originally from Massachusetts, he holds a Master’s degree in Social Work from Boston University. Currently based in Geneva, Switzerland, he has worked in Denmark, Croatia, Bosnia and Herzegovina, Montenegro, Costa Rica and Panama.
This blog is also available on the Global Handwashing Partnership website
October 15 is Global Handwashing Day, an annual advocacy opportunity to raise awareness and promote the practice of handwashing with soap. Handwashing with soap and water at critical times throughout the day may seem like a routine habit for many of us. However, globally it is estimated that only 19% of people wash their hands after contact with excreta.
This is a great shame since we know that consistent handwashing with soap can reduce the risks of disease outbreaks, which pose a critical threat to progress made towards the Sustainable Development Goals (SDGs). Done consistently, handwashing with soap can reduce the risk of diarrheal disease by up to 47%.
While progress is being made to empower communities to end open defecation, the percentage of people gaining access to handwashing facilities is severely lagging, with only one in four people in low-income countries having handwashing facilities with soap and water at home, according to UNICEF and the World Health Organization.
At WSSCC, we are committed to transforming the way communities and people think about sanitation and hygiene. We know that handwashing promotion is most effective when communities are empowered with the knowledge of the five critical times each day when it is vital to wash your hands – after defecation, after cleaning a child’s bottom, before feeding a child, before eating and before preparing food. This knowledge — and these practices — is a crucial factor to ensure that communities take control of their hygiene and health.
Recent surveys of WSSCC’s Global Sanitation Fund (GSF) supported programmes in Malawi and Nepal show that, while progress is being made, we still have a way to go to understand how to translate handwashing promotion into effective practice. In the six rural GSF programme districts of Malawi, we found that a quarter of households do not have access to a basic handwashing facility with soap and water. Using observational research methods, only 18% of people were seen to wash their hands with soap and water following toilet use. This fell to 3% before food preparation.
Understanding how to successfully promote handwashing behaviour is not a problem we are facing alone. While accessing water and soap certainly remains a challenge in rural areas, a main hindrance in the water, sanitation and hygiene sector is the lack of strong knowledge and practices on effective handwashing behaviour change interventions.
WSSCC recently joined forces with the International Initiative for Impact Evaluation (3ie), an international organization promoting evidence-informed development policies and programmes. Together, we reviewed the evidence around promotional approaches that might change handwashing and sanitation behaviour, and analysed which implementation factors affect the success or failure of such approaches.
Not surprisingly, the main conclusion was that community-based interventions may be the most effective method for changing handwashing and sanitation behaviour. While one approach does not fit all situations, it is important that behaviour change facilitators are part of and representative of the community they are working in. This builds trust and familiarity, both crucial components to behaviour change interventions. The gender of the facilitator is also important, as, in many contexts, women and men may prefer to discuss private issues with somebody of the same sex. All of this creates a culture of cooperation and ownership in the community, leading to more promising and sustainable change.
The 3ie/WSSCC review found that community-led total sanitation and interpersonal communication may be particularly effective in changing behaviours around latrine use and open defecation practices. In contrast, common methods based on health messaging were found to be less effective. Studies that use one-way communication in sanitation and hygiene messaging do not seem able to achieve long-term effects on handwashing and latrine use, safe faeces disposal and open defecation.
It is evident that, for behaviour change to be effective, it must be comprehensive. If we are going to be truly successful in changing behaviours and educating communities about the benefit of washing their hands, we must find simple and effective ways of promoting both policy and practice in an effective way.
An urgent push is now needed from a range of actors, across multiple sectors, to understand and improve handwashing behaviour. As we join hands on Global Handwashing Day, we need to work together to generate more evidence on what works, so that we can effectively advocate – not only for commitment, resources and policy change – but also for concrete programming responses that work.
 Freeman MC, Stocks ME, Cumming O, Jeandron A, Higgins JP, Wolf J, Prüss-Ustün A, Bonjour S, Hunter PR, Fewtrell L, Curtis V. Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Trop Med Int Health, 2014 Aug
 Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review, Lancet Infect Dis.
Between 2000 and 2015, the number of people practicing open defecation declined from 1229 million to 892 million, an average decrease of 22 million people per year. See page 5, http://www.who.int/mediacentre/news/releases/2017/launch-version-report-jmp-water-sanitation-hygiene.pdf
 Promoting handwashing and sanitation behaviour change in low-and middle-income countries August 2017, http://www.3ieimpact.org/media/filer_public/2017/08/30/srs10-handwashing.pdf
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