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Before yesterday3. Hygiene

Universal hand hygiene: strategies, sustainable financing and implementation at scale

14 October 2022 at 22:23
This article was originally posted on WaterAid’s website.

By: Dr. Om Prasad Gautam and Sophie Hickling, WaterAid

Om Prasad Gautam and Sophie Hickling discuss the importance of cost-effective handwashing programmes and urge countries to accelerate progress on developing strategies, ensure sustainable financing and scale up implementation to achieve universal hand hygiene.

Handwashing with soap is one of the most effective ways communities, healthcare workers, patients, people in workplaces and schoolchildren can protect themselves and their loved ones from infections and diseases. This year’s Global Handwashing Day theme – Unite for Universal Hand Hygiene – urges governments, donors, businesses, institutions, researchers and advocates to collaborate to create and implement sustainable hand hygiene strategies that will ensure everyone has this vital defence.

Changing people’s hygiene habits for good is only possible if we all unite; from researchers to politicians, donors to governments, activists to businesses, institutions to individuals, we all have a part to play. We need fully costed and funded hygiene strategies, and effective interventions – based on evidence – that can be scaled up to reach everyone, everywhere.

An evidence-based, comprehensive and unified approach empowers people to absorb hygiene into their daily lives, protecting families, lessening the burden on already overwhelmed healthcare services and helping to prevent disease outbreaks and pandemics. Hand hygiene is a cornerstone of public health, and with better health comes fuller lives, stronger economies and brighter futures.

Why is global unity crucial for hand hygiene?

Current progress is too slow.

The rate must increase by at least four times to ensure universal hand hygiene by 2030 at household level. Globally, three in ten people (PDF) do not have facilities at home to wash their hands with soap and water. Only half of health centres worldwide have handwashing facilities with soap and water and just 53% of schools in developing countries provide basic handwashing facilities for students. There is a huge disparity between low- and high-income settings, and between urban and rural locations. Without facilities, people cannot hope to practise proper hygiene and their health and wellbeing are at risk.

Handwashing with soap offers wide public health and social benefits.

It prevents and reduces the disease burden, improves school performance, increases workplace productivity, reduces infections, can prevent the spread of diseases and can help control current and future pandemics. And without hygiene behaviour change programmes embedded at the heart of any water, sanitation and hygiene (WASH), health or education programme, their progress will be compromised.

Hand hygiene is cost effective and offers significant economic benefits.

Handwashing with soap is one of the most cost-effective public health interventions in reducing the global infectious disease burden, costing just US$3 per disability-adjusted life year averted. And investment can bring large economic gains. However, although hygiene interventions are cost effective in the long run, an estimated $12.2–15.3 billion over ten years is needed to achieve universal hand hygiene by 2030 in households alone in 46 LEDCs, of which $4.9–6.6 billion (42%) is for behaviour change promotion interventions and the remainder is for facilities and supplies. However, this equates to less than $1 per person per year (PDF) in these 46 countries.

Prince (4) washes his hands after using the toilet at his house in Shyama Prasad Mukherjee Camp, New Delhi, India.
Prince (4) washes his hands after using the toilet at his house in Shyama Prasad Mukherjee Camp, New Delhi, India. 13 March 2020
WaterAid/ Srishti Bhardwaj


Where should we focus to increase progress?

It’s simple – we can only reach our universal hand hygiene goal if all stakeholders work together. We must start with government leadership and ownership; leaders must work with communities and all stakeholders, including donors, academia, NGOs, civil society and the private sector, to give them the space to collaborate and deliver programmes. And these programmes must be comprehensive, evidence-based, have proof of concept for their effectiveness and have behaviour change woven throughout. Creative and unified methods are required, and it is paramount that stakeholders take the following three actions.

  1. Unite for strategies/roadmaps and planning.

    Having a fully costed national strategy or roadmap for hand hygiene that brings together sectors and stakeholders is vital to provide strategic direction for hand hygiene interventions, ensure institutional mechanisms are clear and functioning, deepen sectoral coordination, strengthen systems and improve quality programming and monitoring.

    As a positive example of collective leadership, around 2021’s Global Handwashing Day, more than 30 countries made a public commitment to develop costed hand hygiene roadmaps. Yet just some have put these into action (including Bangladesh, Pakistan, Nigeria, Ethiopia, Nepal, Ghana) and a few are slowly developing their strategy/roadmap.

    In another example, 16 member states of the Southern African Development Community (SADC) united to develop a hygiene strategy, supported by WaterAid and UNICEF and launched in August 2022.

    In 2021 countries’ efforts centred on developing national costed roadmaps or strategies for hand hygiene in several low- and middle-income countries. This effort should be continued where there has not yet been progress and accelerated where there has. Wider engagement in developing strategies – under government leadership – is vital, including with technical agencies and the private sector.

  2. Unite for sustainable financing.

    The cost of ensuring universal hand hygiene must come jointly from governments, donors and households, and discussion of financing national strategies or roadmaps should go alongside their development. One-off investments are not enough because facilities must remain functional and people continuously reminded to practise hand hygiene. In 2020 UN-Water GLAAS reported that only 60% of national plans for hygiene had been costed and, of those, only 9% had sufficient financial resources to implement plans. If global leaders are to deliver on their sustainable development plans and promises, financing for hygiene must be significantly increased at all levels, long term and coordinated between everyone including households, donors and governments.

    Investing in hygiene is a transformative and critical economic stimulus that every country must include in its efforts to build back better from the COVID-19 pandemic. Hygiene is a no-regrets, smart investment that will increase productivity, reduce health costs and decrease time poverty for the poorest and most marginalised, especially women and girls.

  3. Unite for implementation at scale.

    Achieving sustainable hand hygiene for all requires a big improvement in transformative and inclusive behaviour change programmes at scale. Designing, implementing and evaluating hygiene behaviour change programmes effectively demands a multi-disciplinary approach. Achieving this at scale requires harmonised efforts from governments, donors, NGOs, community-based organisations, the private sector, academia and civil society.

    Global, regional and national-scale implementation must be united; this has been clear throughout the COVID-19 pandemic. Governments should not wait for another public health emergency to invest. Making evidence-based and effective hygiene behaviour change programmes part of wider development programmes is vital to achieving good, cost-effective results on multiple development agendas.

Handwashing facilities at the Basic Education High School (8), Hlaingtharya Township, Yangon, Myanmar.
Handwashing facilities at the Basic Education High School, Hlaingtharya Township, Yangon, Myanmar.
WaterAid Myanmar


How WaterAid is contributing to these focus areas

We champion transformative behaviour change programming, embracing behaviour-centred design approaches to attain sustained behaviour change. We support governments to develop strategies; increase governments’ and partners’ capacities to design and implement hygiene programmes; and allocate and advocate funding for sustainable hygiene behaviour change interventions, showing how effective such interventions can be.

We also work with governments to integrate hygiene behaviour change into sectoral programmes such as health (e.g. immunisation and child health), nutrition and education, and help build or strengthen monitoring and evaluation systems. We create innovative products and facilities with behavioural cues and nudges, working with key partners, including in the private sector.

We emphasise behaviour change rather than just improving knowledge. We are currently supporting 17 behaviour change campaigns across South Asia and Africa, most of which have been altered since March 2020 to include COVID-19 sensitive behaviours.

Through our hygiene campaigns with governments in response to COVID-19 we reached 181 million people during 2020–21, distributed 1.8 million hygiene products and installed 2,700 large-scale innovative handwashing facilities in key public places. In 2022 we are aiming to reach 50 million more people across nine countries with our COVID-19 hygiene response.

We supported the 16 members of SADC region to develop a hygiene strategy and have been helping dozens of countries to develop national hand hygiene roadmaps, supporting a few to cost them. We are a core partner of the Hand Hygiene for All initiative, are a member of the Global Handwashing Partnership, lead the SuSanA Behaviour Change Group and are part of the UK Foreign Commonwealth and Development Office-led C-19 Behaviour Change Group. We have also contributed to various initiatives and sectoral coordination mechanisms through WASH and health clusters. We have produced a range of evaluative documents such as a learning report from our global hygiene response to COVID-19, guides, case studies and blogs. We are also advocating the need for national strategies, sustainable financing and implementation of hygiene behaviour change programmes at scale in many countries.

We are committed to continuing to support global unity and collaboration on hand hygiene, to prioritising hygiene as a core focus and to advocating united action for sustained behaviour change.

Om Prasad Gautam is Senior WASH Manager – Hygiene at WaterAid UK. Sophie Hickling is Senior Policy Analyst – Hygiene at WaterAid UK.

Top image: Addisae, 14, using a tap stand built by WaterAid in her community in Wundiye, Burie, West Gojjam, Ethiopia.

Accelerating availability of better hand hygiene

13 October 2022 at 02:40
This article was originally published on SATO’s website. 

By: Erin McCusker, Leader at SATO 

In 2021, I wrote of the pivotal opportunity to sustain the improved access to handwashing emerging from the increased consumer awareness and government-led communication of the benefits of hand hygiene particularly to stop the spread of COVID-19.   

To create long-term changes in behaviour and levels of access, we have since focused on accelerating availability of our award-winning hygiene solution, the SATO Tap. 

Over 2021 and 2022, in response to Covid and as part of LIXIL’s $1 million commitment to help accelerate the rollout of the SATO Tap, we are distributing the first 500,000 units produced of the SATO Tap through our partners such as UNICEF to rapidly reach consumers and communities.  

In February 2021, we commercially launched the product in India at a suggested retail price of under $3, to make it available through retailers and distributors, and beat our initial sales projections. Its affordable, portable, and water-saving design – the SATO Tap uses just 100ml per wash, 90% less than traditional counterparts – makes it an easy-to-implement solution to address India’s handwashing challenge, where an estimated 444 million people have limited or no access to basic hygiene facilities.  

Establishing a supply with local manufacturing and distribution partners is only one piece of the coordination required. Our teams on the ground showcase the benefits of improved hand hygiene to local communities to build demand. In Odisha and Bihar, we provided soapmaking training to more than 75 women of WASH HAAT, a group of masons and sanitation entrepreneurs who already work with SATO. This not only provided a new skill in terms of producing soap, but also introduced the women to the benefits of handwashing and the SATO Tap.  

For Hand Hygiene Day in May, we reached out to street food vendors and nearby retailers in Nagpur in Maharashtra and Puri in Orissa to showcase the tap and talk about the importance of hand hygiene. Street food is a common part of Indian society, but a lack of access to basic hand hygiene facilities within food markets creates an increased risk in the spread of preventable diseases. Over two days, we spoke to more than 150 street food vendors and introduced the SATO Tap, which received very positive feedback.  

Globally, the SATO Tap has impacted the lives of more than three million people – including 1.2 million people in India through partnerships and commercial sales. Now, driven by the success achieved to date, we are pleased to commercially launch the SATO Tap in Tanzania, our first African market for the product. Our established supply chains in these two markets – and across two continents – create a strong foundation for us to accelerate availability of the SATO Tap.  

But, we cannot solve the hand hygiene challenge alone. In the past five years, more than 500 million people have gained access to basic hand hygiene services at a rate of 300,000 per day1. Progress, but slow progress. At this rate, almost two billion people will still lack access to basic hand hygiene facilities in 2030.2  

The impact of lack of access to basic hygiene cascades into health and economic impacts. Ensuring everyone has somewhere to wash their hands with soap and water will generate $45 billion per year, while reducing the spread of infections like COVID-19 by up to 20%.3 

Although the scale of the hygiene and sanitation challenge is daunting, the opportunity to create a better life, every day, for communities is tangible.  We require the mobilisation of all stakeholders, from governments to NGOs and the private sector, to unite for universal hand hygiene.  

Improving cross-sector collaboration is one of the reasons why LIXIL joins the Global Handwashing Partnership (GHP) – a coalition of international stakeholders who work to advocate for and promote handwashing with soap. We join GHP’s network of handwashing champions, collaborating with across sectors to share knowledge and ideas to accelerate access to improved hygiene.  

We have already seen great success in adopting coordinated cross-sector efforts to create solutions. The SATO Tap was created by our team leveraging valuable insights and feedback from UNICEF’s network in more than 100 countries. Feedback from users and stakeholders, including from industry partners and the most remote communities, enabled us to create a solution that addressed specific consumer challenges, as well as address gaps left by other handwashing solutions. What communities wanted was water efficiency, simplicity, and affordability – all key elements of our award-winning design. 

Developing a great solution is only the first step in addressing the challenge. The next step, and arguably where we require most cross-sector collaboration, is in creating long-lasting hygiene markets. Across our entire SATO business, we are building supply chains with local manufacturers, growing sales networks with retailers and distributors, and demonstrating the benefits of better hand hygiene to drive demand.  

The private sector, particularly businesses which have supply chains established in regions with low access to hand hygiene, have a responsibility and a business opportunity to drive this forward. To ensure that we don’t face a crisis where two billion men, women and children continue to live without access to handwashing solutions at the turn of the decade, everyone must unite to accelerate hand hygiene access and create better lives, every day.  

The Handwashing Handbook is now available in six languages

11 October 2022 at 03:20

By: Aarin Palomares, Global Handwashing Partnership

Nearly two years ago, the Global Handwashing Partnership launched the Handwashing Handbook. The handbook serves as a comprehensive resource for hand hygiene programming in a variety of contexts. It guides users through the case for hand hygiene, how to design and implement hand hygiene behavior change programs, how to integrate hand hygiene into other related programs, and how to address hand hygiene at a systems level. 

The Handwashing Handbook represents a collection of experiences, best practices, and new concepts to improve the uptake of handwashing and for two years, it has only been available in one language – English. We’re excited to announce the Handwashing Handbook is now available in six key languages. Along with English, the Handbook is now available in Arabic, Chinese, French, Portuguese, and Spanish, ensuring more people have access to the critical content the handbook provides. 

Check out the Handwashing Handbook here

Stronger systems for water, sanitation and hygiene: how do we know we are making progress?

8 October 2022 at 05:11
This article was originally published on WaterAid’s website.

By: Fraser Goff, Sokkung Sou and Tina Chum

After five years of strengthening systems for inclusive, lasting, universal access to water, sanitation and hygiene (WASH), what have we learned about the use of system building block assessments to design interventions and monitor the strength of WASH systems? Fraser Goff, Sokkung Sou and Tina Chum reflect.

Ensuring inclusive, lasting and universal access to WASH services and behaviours is not something WaterAid can do alone. Our approach seeks to strengthen WASH systems – the networks of people and institutions, and the contextual factors they interact with such as policies, budgets, data systems and social norms – so that everyone can have equitable access to lasting WASH services, and practise hygiene behaviours, for good.

Thinking and talking about WASH systems can quickly raise some complex questions:

  • How do we design programmes to strengthen WASH systems, and where should we start strengthening the system if there are many challenges and gaps?
  • Which people and institutions need to be involved, and how do we make sure the voices of community members and people who experience marginalisation are heard?
  • How does an organisation like WaterAid engage with different stakeholders from government, rights groups, private sector and civil society, while also making sure they fulfil their WASH roles and responsibilities and don’t become dependent on us?
  • How do we know if we are making progress towards a stronger system?

Strengthening WASH systems through our Sustainable WASH Programme

In the past five years, we have been learning about how to strengthen WASH systems through the Sustainable WASH (SusWASH) Programme, which aims to strengthen systems for sustainable and inclusive WASH in Cambodia, Ethiopia, Pakistan and Uganda. Read more about what we have learned from the SusWASH programme in our global learning report.

In the SusWASH Programme, we have used a framework called ‘Building blocks of the WASH system’ to help make engagement with WASH systems more accessible and practical for programme participants from WaterAid, governments, communities, private sector and civil society. The building blocks are the components needed for a well-functioning system to reach everyone with lasting WASH – coordination, strategic planning, financing, monitoring and leadership. Although building block frameworks have limitations – for example, they can over-simplify the system, and can make it hard to think about the interconnected and dynamic nature of systems – for NGOs like ours they can still be a useful way to understand the functions, bottlenecks and entry points for programme activities.

WaterAid’s building blocks for a well-functioning WASH system.


In the SusWASH Programme in Kampong Chhnang Province, Cambodia, we used the WASH system building blocks to facilitate participatory discussions with government and non-government actors to identify where our efforts should be targeted. In each year of the programme, we discussed and analysed the strengths and weaknesses of each building block and assessed whether stakeholders thought the building blocks were weak, medium, strengthening or reaching a desired state (see example below of the assessment tool used in Cambodia). This helped everyone to identify what parts of the system were functioning well and what priorities we needed to work on together to improve further.

The pros and cons of using building block frameworks in WASH systems strengthening

After five years of using the building blocks for participatory assessments, what has the WaterAid Cambodia team learned about the value and limitations of using building block frameworks (PDF) in WASH systems strengthening programmes?

1. Participatory building block assessments can be a valuable tool for implementing systems strengthening programmes. Annual discussions among stakeholders provide a regular rhythm for reflection, action planning and programme adaptation.

2. Participatory building block assessments can introduce concepts of systems to stakeholders who are less familiar with thinking in this way. Talking about system building blocks helps to make the intangible ideas of a system more tangible (although they over-simplify and silo different system functions) and can provide a useful framework for building shared understanding among stakeholders about what they need to do together to improve the system.

An extract from WaterAid Cambodia’s contextualised building block tool. More detail at https://washmatters.wateraid.org/sites/g/files/jkxoof


3. Comparing building block assessments results over time can help to demonstrate changes in the system and contribute to evidence of the impacts of systems strengthening programmes, but should not be the sole monitoring approach. The results from building block assessments can add structure to programme monitoring when combined with qualitative evidence about programme activities and other context changes, as well as quantitative evidence of service level improvement. However, these building block assessment results should not be relied on as the only source of programme monitoring evidence.

4. Participatory building block assessments are not an ideal measurement of overall system strength. Comparing assessment results from year to year can help to visualise change occurring within the system over time, but each year’s assessment results are not a good measure of system strength at a point in time, because:

  • The results are very subjective
  • Individual building block assessments do not necessarily reflect how the whole system functions.
  • Sensitive elements of the WASH system – such as relationships (both formal and informal), individuals’ use of political influence to progress/prevent change in the WASH system – are not well captured in the building block framework.
  • Building block descriptions are more likely to reflect whether a system function (e.g. planning, budgeting) is being performed than the quality of the function.
  • The assessment rubric (the descriptions of each building block at states of weak, medium or strong) represents the vision of the system by whoever defines it. For the rubric and results to reflect the vision of the local sector it should be co-created with stakeholders.

The above lessons indicate significant value in including regular participatory building block assessments in WASH systems strengthening programming to design (PDF), monitor and adapt interventions. In our new strategy, we are integrating these assessments as one approach in our monitoring and evaluation of systems strengthening.

You can read more about the lessons we have learned about using building blocks for designing, implementing and monitoring systems strengthening programmes in our learning synthesis report (PDF) or on our SusWASH project page.

Fraser Goff is Regional Systems Strengthening Technical Lead at WaterAid Australia. Sokkung Sou is Head of Programmes at WaterAid Cambodia. Tina Chum is Provincial Coordinator at WaterAid Cambodia.

Top image: WASH stakeholders from Kampong Chhnang discuss the building blocks of the WASH system.

Gender considerations for hygiene programming: Insights from the 2021 Handwashing Innovations Think Tank

7 October 2022 at 05:00
This article was originally published on FHI 360’s website.

By: Aarin Palomares and Morgan Toth

The past five to ten years highlight the increasing focus on delivering more inclusive water, sanitation and hygiene (WASH) programming. Spurred on by the Sustainable Development Goals, program implementers must go beyond business as usual and consider other dynamics that impact WASH practice. For example, gender plays a significant role in hygiene interventions (i.e., hygiene needs of women and girls often vary from those of men and boys), yet implicit gender bias remains within hygiene program design and implementation.

As women ourselves, we question what can be done to ensure more gender transformative hygiene programming. The Handwashing Innovations Think Tank addresses this question (and many more) by bringing together global experts to reflect on key challenges and spur new ideas for change to accelerate hand hygiene progress. In this post, we discuss insights from the Handwashing Innovations Think Tank and offer gender considerations for hygiene program implementers.

Getting on the same page: Sex, gender and their intersectionality for hygiene programs

The concepts of sex and gender are important to differentiate in the context of hand hygiene needs. According to the Bill and Melinda Gates Foundation, sex is defined as “the biological categorization of a person as male, female or intersex,” while gender is classified as “the socially and culturally constructed ideas of what it is to be male or female in a specific context.” Unlike sex, gender is socially constructed and not biologically determined. Thus, gender norms and practices are solely based on social and cultural beliefs, and they can change and evolve. This is evident in the roles, responsibilities, attitudes and behaviors that society considers appropriate for males and females, independent of an individual’s own identity and expression. An intersectional approach acknowledges the differences within and among groups of men, women and gender non-conforming individuals, and seeks to understand how these differences create unequal opportunities and access to resources.

In the Think Tank, we reflect on these nuances and consider how this may affect an individual’s hygiene needs and practices. Dr. Bethany A. Caruso, an Assistant Professor at Emory University, provides examples of sex and gender-specific hand hygiene needs in her Think Tank presentation. For example, the need for hand hygiene during menstruation, post-pregnancy and other vaginal bleeding is sex-specific, whereas changing diapers, preparing food or caring for sick relatives is gender-specific. This is important when considering gender expectations related to hand hygiene needs. Hygiene-related household tasks often fall on women and may impact their overall wellbeing. A systematic review by Kayser et al. (2019) reports four out of five households rely on women to collect water, which leads to an increase in adverse health consequences such as back pain, stress and anxiety, and can even affect a woman’s safety. Overall, these examples represent compounded forms of discrimination that amplify a person’s individual constraints and opportunities to practice hand hygiene.

Evaluating a hygiene program’s gender-responsiveness

The World Health Organization Gender Responsive Assessment Scale defines criteria to assess programs and policies (see figure below).

Figure 1: Illustration of the WHO Gender Responsive Assessment Scale

Figure 1: Illustration of the World Health Organization Gender Responsive Assessment Scale

Based on a set of standardized questions, this scale classifies a program’s gender-responsiveness. This type of evaluation is critical in generating and using evidence to improve what we do to achieve gender equality through hygiene programs. Using this scale, we describe two approaches discussed during the Think Tank.

The first example highlights unintended consequences around gender in some hygiene programs. The SuperAmma (SuperMum) intervention, developed by the London School of Hygiene and Tropical Medicine, emphasizes the role of mothers as primary caregivers. Biran et al. (2014) find the intervention’s use of emotional drivers and social norms particularly effective in increasing handwashing behavior for a sustained amount of time (12 months). While the intervention acknowledges gender norms, it inadvertently aligns with stereotypes by placing emphasis on mothers as the primary caregiver. This type of approach aligns with many existing (well intentioned) hygiene programs that accommodate gender but fail to level the playing field. Adopting a “good parent” approach would have been more equitable. This showcases the need for an iterative learning process as programs move from accommodating gender to transforming harmful gender roles within hygiene programs.

Achieving gender equity requires mutual recognition and engagement from women and girls, as well as men and boys. Our second example features a shift in program design and emphasizes equal division of household and care duties. Mum’s Magic Hands, implemented by Oxfam in partnership with Unilever-Lifebuoy, aims to address common barriers and motivators, such as nurture and affiliation, to encourage handwashing with soap in emergency-affected communities (Tolani, 2017). While the program primarily targets mothers, it also makes a concerted effort to address both male and female family members. This encourages men to reflect on gender and care roles in their household and gives men more ownership for change. This simple switch (i.e., engaging men in this intervention) showcases how organizations can adapt their programs to address the root causes of gender inequality within a household, while maintaining their goal for improved hygiene behavior.

Assessing a program by its level of gender-responsiveness allows us to take a critical look at existing norms and visualize our impact in achieving gender equality as it relates to hygiene needs. These approaches showcase a range of responses and program adaptations. Overall, evaluating how a program addresses gender needs helps us reimagine the future of hand hygiene.

Reflecting on how to address gender equity in hygiene programming

Considering the principles of habit for hand hygiene, we think it is important for program implementers to understand where burden (blame) falls for creating the enabling environment (i.e., access to water and soap) and note how certain behavioral interventions may enforce gender norms (i.e., what it means to be a “good mother” or “good wife”). When incorporating gender into hygiene programs, we must consider the following questions: Why does the program engage women or girls? Is it solely for the purpose of achieving program goals? Does the program benefit women and/or girls and according to whose perspective?

At all stages during program design and implementation, programs must reflect on how they address gender equity. It is important to build in time to reflect on how each program may influence gender norms and consider unintended consequences. By reflecting on existing gender roles and dynamics, programs can avoid stereotyping and instead utilize common norm-based behavior change techniques that are based on shared values and centered around humanity as a whole. In understanding these dynamics, hygiene programs will ultimately be more inclusive and address the root causes of gender-based health inequalities.

Photo credit: Unilever; used with permission

Note: To learn more about other topics discussed during the Handwashing Innovations Think Tank, view the report here.

An Eye to 2030: Making NTD Gains in Kenya Through WASH

30 March 2021 at 15:03

Written by Stephen Hilton, Global Water 2020 on behalf of the NTD NGO Network’s Water, Sanitation and Hygiene Working Group

On World Water Day 2021 (March 22), the World Health Organization officially released its 2021-2030 Global Strategy on Water, Sanitation and Hygiene (WASH) to Combat Neglected Tropical Diseases (NTDs). The Global Strategy is one of several official companion documents to the 2021-2030 NTD road map, which launched in January for World NTD Day 2021 and included, for the first-time, a cross-cutting indicator for WASH that countries must meet by 2030; that is: universal WASH access in all NTD endemic areas.

Today, WHO is celebrating the launch through an online event to catalyse new partnerships and inspire commitments across the WASH and NTD sectors, in terms of funding, policymaking and joint programming. The event features global, regional and national perspectives around successful WASH and NTD collaboration with an eye to 2030, including from Kenya where the Ministry of Health has been a true leader for this important, life-sustaining work.

A headshot of Dr. Sultani Matendechero

To mark the launch of the Strategy, Global Water 2020’s Stephen Hilton, on behalf of the NTD NGO Network’s (NNN) WASH Working Group, caught up with Dr. Sultani Hadley Matendechero, Director of Kenya’s Division of Vector Borne and Neglected Tropical Diseases at the Ministry of Health. His department coordinates multi-sectoral programming to control and eliminate NTDs, such as soil-transmitted helminthiasis, schistosomiasis, lymphatic filariasis, and trachoma—diseases that remain prevalent throughout Kenya. Dr. Matendechero, who is a pharmacist by profession, has been a strong advocate for providing access to safe WASH services, which is essential for the control, elimination and eradication of all NTDs across the continuum of prevention, treatment, care and morbidity management.

What motivates you to integrate WASH into your NTD programming at the Kenyan Ministry of Health?

SM: Over time, I have realized the importance of safe water, basic sanitation, and general hygiene in controlling and eliminating NTDs. Yes, we use pharmaceutical interventions like Mass Drug Administration (MDA), which can rapidly bring down disease prevalence to remarkably low levels. Unfortunately, I noticed that a few weeks or months later, the prevalence bounces back to the pre-MDA levels. We have demonstrated that one of the main reasons behind this loss of gains is the absence of WASH interventions. That’s why I believe that for our pharmaceutical interventions to be meaningful, we must have sufficient WASH facilities in place. If adequate WASH interventions are implemented, up to 70% of the problems with NTDs will automatically resolve.

What is an example in Kenya that demonstrates how important WASH can be for controlling NTDs?

SM: Before 2007, Kitui County was among the known trachoma-endemic areas in the country. Following the coming into power of a new government in 2007, many water projects were established in Kitui as part of the new government’s drought relief program. When we conducted a routine assessment for trachoma in 2016, we realized that trachoma had been eliminated in Kitui. It took us some time to realize that the WASH interventions which had been inadvertently put in place by the drought relief program, could have played a fundamental role in this development. This is because clean faces are incompatible with trachoma and the availability of water must have spurred behaviour change which led to more frequent face-washing within the area. Because of this elimination of trachoma in Kitui, we saved more than 300 million shillings annually, which would otherwise have been used in implementing mass treatment interventions against trachoma. Further, we estimate that the investment that was put in WASH is less than 20% of what we would have spent on MDA alone. One can only wonder what the substantial amounts of money saved can do… build several community hospitals perhaps? Invest in education programs or community youth empowerment programs? Your guess is as good as mine.

What challenges have you faced in Kenya with integrating WASH and NTDs nationally and locally?

SM: The biggest challenge is the wrong perception that the installation of WASH facilities is a very expensive exercise. However, by establishing functional and working relationships with other stakeholders, including in the WASH sector, you do not need a ton of money. Many stakeholders are resistant to change, such as embracing a paradigm shift towards closer partnerships that enhance the provision of WASH interventions for NTD control. Many WASH stakeholders may initially feel that these partnerships can only be a one-way relationship where only the NTD sector benefits. To address this, we have come up with innovative ways of ensuring that the WASH sector benefits just as much as the NTD sector. We even spell out the benefits to the WASH sector and other stakeholders in our Breaking Transmission Strategy (BTS).

What have you done to overcome challenges associated with cross-sectoral coordination?

SM: We have established a very robust government-led coordination mechanism for NTDs in our BTS, which I encourage other countries to emulate. NTDs are unique diseases that require everyone to contribute to control and elimination.

There is a National NTD Steering Committee with high-level representation, whose chairmanship is at the cabinet secretary-level. This committee ensures coordination, sustainable resource mobilization, and more. We involve multiple departments so that we can capitalize on the work they already do. We include research institutions such as the Kenya Medical Research Institute (KEMRI), the International Centre of Insect Physiology and Ecology (ICIPE), and academic institutions like the University of Nairobi. Local experts in the NTD field have been officially engaged to advise the steering committee. We also have technical advisory groups comprised of implementers and experts for specific diseases. They bring people from all sectors to deal with cross-cutting issues such as WASH and behaviour change communication, among others. This coordination mechanism ensures that we have dozens of people from all sectors at the national- and subnational-levels intimately participating in the day-to-day running of NTD control activities.

Structure for implementing the BTS, adapted from the Kenya National BTS (page 46).

What accomplishments are you most proud of?

SM: We reactivated many programs to great success. For example, after reorganizing our efforts on lymphatic filariasis in 2015, we have implemented a remarkable raft of interventions over the last six years. We are now looking forward to implementing transmission assessment surveys this year, which we expect will confirm the elimination of the disease from Kenya. This will be an enchanting addition to our list of achievements after attaining certification of Guinea worm disease eradication in Kenya only two years ago.

What role do you see the new 2021-2030 NTD Road Map, as well as accompanying Global Strategy on WASH and NTDs, playing in accelerating progress on WASH and NTDs this next decade?

SM: We adopt international guidelines, strategies, and roadmaps into many of our plans, such as the BTS. The three pillars of this plan are to increase coverage of MDA, expand WASH interventions, and mainstream behaviour change and communication activities, in addition to other interventions such as integrated vector management and effective monitoring and evaluation. This year we are going to review our national strategic plan for NTDs and we are going to borrow heavily from the NTD roadmap that has been launched by WHO. This will include expanding the WASH and behaviour change and communication pillars, which will read well when seen against the backdrop of the BTS.

What are the next steps for WASH and NTD coordination in Kenya?

SM: We have rated coordination as the most important aspect of NTD control, and are looking to improve it. We are expanding the membership of our committees with more technical experts and strengthening partnerships by involving more stakeholders in the NTD/WASH technical working group. We want to create new external partnerships and have been having meetings in the afternoon so we can involve stakeholders in America and Europe. With lymphatic filariasis out of the way, we are shifting our full attention towards trachoma elimination. This is an objective we expect to meet within the next five years at a maximum.


We’ll be ramping up the BTS. Within the next two to three years, we should be able to scale up BTS implementation to more than 30 targeted counties. We’re also beginning implementation in order to eliminate schistosomiasis and soil-transmitted helminthiasis in all areas where elimination is possible. Moving forward, we want to ensure that we don’t just pay attention to MDA, but ensure that WASH and behaviour change and communication are at the centre of our implementation as well.

New Opportunities for WASH and Health Integration

2 February 2021 at 14:42

This blog was originally posted on the DefeatDD website. 

A mother in Vietnam helps her children wash their hands while wearing face masks. The COVID-19 pandemic has made clear the links between health and handwashing.

Health and water are inextricably linked. Yet, policies and programs related to water, sanitation, and hygiene (WASH) are too often kept separate from public health policies and programs. The need for coordination between the WASH and health sectors is a drumbeat that we have been sounding for more decade, and the COVID-19 pandemic has highlighted the central role that measures like handwashing with soap and WASH in health care facilities play to keep communities healthy. When health and WASH improvements reach children in a holistic way, they offer greater efficiencies and impact. The same is true for joint advocacy for the two issues.

To serve this purpose, DefeatDD founded the Health/WASH Network in 2009 in partnership with WaterAid. For more than a decade, the Network has served as a collaboration opportunity for a diverse set of advocacy organizations working across child health, maternal health, immunization, water, sanitation, and hygiene. As health programming grew more integrated over the years, we came to recognize that, to push WASH and health integration to the next step, we’d need to reach even more groups.

That’s where CORE Group came in. CORE is a global health advocacy organization that convenes practitioners and public health professionals in global community health to share knowledge, evidence, and best practices and advances dialogue at the country and global levels. The Health/WASH Network connected with CORE Group about the possibility of transferring the Network into a CORE Interest Group to tap into CORE’s existing broad membership and reach. They agreed, and in fall 2020, the new WASH and Health Interest Group was born!

We are thrilled that this new interest group is being co-chaired by Aarin Palomares of FHI360, Benjamin K. Masila of FHI360 Kenya (Afya Uzazi WASH), and Moses Mathenge of WaterAid Kenya. Its membership reflects a community of people dedicated to elevating WASH and health integration, building on existing efforts and leveraging new opportunities to bring the intersection of WASH and health to the forefront.

While the group is still new, it’s off to a running start. On Wednesday, January 27, 2021 the group hosted a session at CORE Group’s virtual Global Health Practitioner Conference entitled Building Bridges between WASH and Global Health: Integrated Strategies to Improve Child Health. Speakers from FHI 360 Kenya, UNICEF India, World Vision, and IMA World Health highlighted the importance of integrating WASH and nutrition, WASH in health care facilities, WASH and animal husbandry, and WASH and neglected tropical diseases. The session emphasized cross-sectoral partnerships and engagement, breaking down silos, and coming together to improve child health outcomes.

We believe the future of global health—and our planet—relies on deliberate partnership and integration. This new group and others like it are helping bring the WASH and health sectors together to solve big problems. As Kaninika Mitra of UNICEF India shared during the conference session, “WASH is the responsibility of everyone.”

We hope you’ll join us!

To join the new WASH and Health Interest Group, subscribe here. You can also email the group member listserv at wash@lists.coregroup.org.

Hand hygiene for all: Beat the virus today and ensure better health beyond the pandemic

15 October 2020 at 16:22

By: Soma Ghosh Moulik, Practice Manager, World Bank

This post was originally posted on the World Bank website. 

October 15 was Global Handwashing Day, with its clarion call that to beat the virus today and ensure better health outcomes beyond the pandemic, hand hygiene must be a priority now and in the future.

Today, nearly half of schools across the world lack handwashing facilities with water and soap, affecting 900 million school-age children. And in 16 percent of healthcare facilities, there are no handwashing facilities in the areas where patients receive care or near the toilets. Without access to safe water and sanitation services and effective hygiene protocols, many of our client countries will be unable to re-open schools, workplaces and other public spaces, and health services will continue to be limited. This threatens to reverse years of hard-won gains in human capital.

The World Bank along with its partners – UNICEF, WHO, and others – is committed to galvanizing government-led programs and working across sectors to prioritize the delivery of hand hygiene for all. These programs will succeed with proven transformative models, requiring:

  • Political leadership and commitment at the highest level to create the political, societal, and behavioral changes to deliver hand hygiene services to more people, more efficiently.
  • Strong enabling environment built through institutional arrangements and public and private finance and credible information to deliver and sustain services while also improving policies, incentives, capacity and regulations to support the water sector to operate more efficiently.
  • Partnerships to address the scale of investments required for robust supply and demand, crowding in the private sector and tapping innovations in service delivery.
  • Inclusive participation is essential, whether it’s public participation in the design of handwashing stations, or citizens’ response to trusted communications for building a movement for behavioral change in hygiene practices.

The World Bank’s water teams have been working closely with countries and partners to ensure communities have access to fixed and portable handwashing facilities, soap or alcohol-based hand rubs, and reliable water supplies.  We are also helping people understand the benefits of handwashing through educational and behavioral tools and tactics.

  • In Ghana, the Greater Accra Metropolitan Area (GAMA) Sanitation and Water Project is providing WASH facilities in 260 school compounds (some compounds have more than one school) with separate blocks for girls and boys. Each school is provided with water supply and adequate handwashing facilities, both within and outside the toilet blocks so that children can access the handwashing facilities easily and more frequently.
  • In Haiti, the Sustainable Rural and Small Towns Water and Sanitation Project supported the Regional Water Supply and Sanitation Office (OREPA) in launching a large-scale public awareness campaign, improved handwashing facilities, and the provision of  water trucking to underserved areas. The campaign promoted good handwashing behavior, hygiene, physical distancing, and the use of face masks by deploying posters, videos, social media messages, radio announcements, and recordings broadcast from cars and motorbikes. In partnership with UNICEF, the project financed two programs to install 390 handwashing stations at critical locations, including in densely populated places like markets, orphanages, prisons, and health care centers.
  • In Kyrgyz Republic, the Sustainable Rural Water Supply and Sanitation Project has hired social mobilization specialists to train village health committees, to ensure that even the most remote areas are reached. The campaigns also include a variety of interactive exercises designed specifically for school children, including activities like “Glow Germ” to demonstrate hand contamination, the formation of student “WASH committees,” and school sanitation competitions. This is being done alongside the upgrading of toilets and hygiene rooms for girls in schools, and engaging school administrators and parents to ensure that soap and toilet paper are available.
  • In Indonesia, the country’s Community Based Drinking Water Supply and Sanitation program, or PAMSIMAS, has focused on a community-driven approach to behavior change for adoption of good hygiene practices. By empowering communities and local-level institutions to develop solutions that work best to meet their specific needs, many have been able to eliminate poor sanitation and adopt sound hygiene practices. For example, in the Samustida Village, the program’s facilitator coordinated with various stakeholders to help build fifteen handwashing facilities with adequate water supply and soap. In the Kedungmundu Village, on the other hand, the community proactively sprayed disinfectants in mosques and distributed free face masks. These activities were funded by the PAMSIMAS village fund.
  • In Sri Lanka, the Water Supply and Sanitation Improvement Project in Sri Lanka has been supporting and organizing intensive hygiene promotion programs to educate communities — especially schoolchildren — on practices such as handwashing, proper use of latrines, menstrual hygiene, and preventing the contamination of water sources. Targeted messages and resources have been provided in local languages to ensure their relevance and effectiveness. And hygiene programs have been rolled out in schools so young people can share what they learned with their friends and families.
  • In Yemen, the Emergency Health and Nutrition Project (EHNP) in Yemen has carried out several critical WASH interventions, including the distribution of hygiene kits, chlorine tablets, jerry cans, disinfection materials and storage, as well as hygiene promotion centered on key practices such as handwashing with soap, food hygiene and proper use of latrines. Rapid Response Teams have conducted house-to-house campaigns in 20 governorates. To protect people from COVID-19, EHNP is also continuing to help repair and upgrade water and sanitation systems and install or replace handwashing sinks in health care facilities and schools.

Manila Water Foundation Helps Bring Hand Hygiene for All

26 October 2020 at 20:32

In the Philippines, Manila Water Foundation (MWF) is the only local organization that is a member of the Global Handwashing Partnership (GHP).  MWF is the social development arm of Manila Water, a water utility subsidiary of the Philippines’ oldest conglomerate, servicing over seven million people in Metro Manila. Founded in 2005, MWF aims to enable change through sustainable water access, sanitation, and hygiene (WASH) education in marginalized communities in the Philippines.

In celebration of the 2020 Global Handwashing Day, MWF continues to build on its parent company’s strengths to contribute to the global campaign, using a participatory, responsive and holistic approach. Through its Health in Our Hands (HiOH) Program, MWF furthers the advocacy of handwashing with soap and clean water as a way to prevent communicable diseases and illnesses such as COVID-19.

Anchoring on this year’s theme, “Hand Hygiene for All”, MWF highlights inclusivity with its wide-ranging campaign, reaching as many people as possible, even in a time of restricted movement and physical distancing.

MWF embarked on a month-long celebration of Global Handwashing Day with several initiatives in October, aimed at addressing the issue of water access, sanitation and hygiene, and providing access to the information, supplies, and facilities needed for safe handwashing across the three island groups in the country – Luzon, Visayas, and Mindanao. This includes the construction of handwashing facilities across the National Capital Region, starting last October 12 with the installation of a 10-faucet hygiene facility at the Ramon Magsaysay High School in the City of Manila, followed by turnover of hygiene facilities at the Marikina Sports Center, and more installations at the La Mesa Ecopark and at the Tahanang Walang Hagdanan, an institution providing services to persons with disabilities.

On October 15, MWF organized a virtual celebration bringing together collaboration partners from the public and private sectors such as the GHP, the Department of Health, Department of Education and UNICEF Philippines. MWF partnered with Procter & Gamble, Safeguard Philippines and PHILUSA Corporation, for the distribution of thousands of hand hygiene supplies to city jails, orphanages, homes for the elderly, indigenous communities among the Mangyans in Mindoro and the Dumagats in Sitio Calawis in Antipolo City, Rizal. Hygiene supplies and information and education materials will also be provided to public institutions in Boracay, Cebu City, Davao City and Zamboanga City.

For more information about this year’s MWF Global Handwashing Day celebration and HiOH program, you may refer to the website here.


Global Handwashing Day Interview with NNN Vice-Chair, Arielle Dolegui

16 October 2020 at 16:02

This interview was originally posted on the Neglected Tropical Disease NGO Network website.

Combining hand hygiene and broader water, sanitation and hygiene (WASH) interventions with NTD programs is one of the most cost-effective ways to improve public health. WASH, including hand and face washing, prevents NTDs like trachoma, soil-transmitted helminthiasis (STH), schistosomiasis and Guinea worm disease, and is needed for safe and dignified treatment and care. Hand hygiene is also effective at preventing other infectious illnesses, such as COVID-19. To commemorate Global Handwashing Day 2020, the NTD NGO Network (NNN) has committed to ensuring hand hygiene for all. It strives to support cross-sectoral political leadership, create an enabling environment, and promote sustainable and inclusive programming at scale.

Cross-sectoral partnerships are nothing new for NNN’s Vice-Chair, Arielle Dolegui. As a Technical Advisor for Health Systems Strengthening and Cross-Sector Coordination at World Vision, supporting the USAID-funded Act to End NTDs | West program, Arielle brings to the NNN a wealth of experience at the intersection of WASH, NTDs and education.

For Global Handwashing Day today, NNN WASH Working Group Chair and Director of Policy and Communications at the SCI Foundation, Yael Velleman, interviewed Arielle for her insights on the challenges and opportunities for coordinated programming, as well as the role of the NNN in driving this work forward and at scale as to realize hand hygiene for all.

As a Technical Advisor to World Vision, you’ve worked at the intersection of WASH, NTDs and education. Please tell us about your experience, and the impact you’ve seen on-the-ground from such coordinated programming.

In my role at World Vision, supporting the USAID-funded Act to End NTDs | West program, we have supported the institutionalization of cross-sector coordination of NTD programs. For example, we have supported the Ghana Health Service/National NTDP with the revamping and relaunch of their multi-sector coordination mechanism–the Intra-Country Coordinating Committee (ICCC)–to facilitate integration of NTDs into the national health systems’ priorities and policies and engage key sectors such as WASH and education for joint planning and implementation to sustain the elimination and control objectives of NTDs in Ghana. This has been a tremendous achievement on-the-ground as streamlined cross-sector collaboration remains the cornerstone strategy for effective NTD programming and a testament to country ownership and political will to move the NTD sustainability agenda forward. In Senegal, Sierra Leone, and Niger, we have also supported the Ministries of Health leadership in restructuring their multi-sectoral interventions, leveraging existing robust partnerships with the education sector while building and strengthening the nascent collaboration with the WASH sector to support both service delivery integration as well as behaviour change strategies and interventions.

The WASH UP! Initiative you lead teaches children proper hygiene practices to prevent NTDs via muppet ambassadors, Raya and Elmo. What additional innovations are needed to promote and sustain behaviour changes? How can the NNN promote such best practices?

WASH UP! is a school-based program that World Vision implements in over 11 countries in collaboration with Sesame Workshop and Ministries of Education. This program was expanded to include NTDs, specifically schistosomiasis and STH, as a pilot in Ghana and Niger. The play-based curriculum aims to promote positive WASH attitudes and behaviours among children and their school communities, including those with disabilities, with a focus on vulnerable populations. Targeted behaviours in the WASH UP! curriculum include safe water and food practices, increased latrine use, improved waste management, consistent handwashing, good personal hygiene, and kindness to all, including those who are sick and/or disabled.

World Vision has a long history of providing clean water and access to sanitation for millions of children and their families, a critical element in the prevention of NTDs. World Vision’s WASH programs focus on five key aspects: capacity building, sustainable water supplies, hygiene behaviour change, sanitation, and strengthened networks and management capacity among various stakeholders, including both government and communities. Recent projects include constructing and rehabilitating community latrines, digging wells, mobilizing communities to be declared Open Defecation Free, and promoting handwashing. In Zambia, World Vision supported the School Health and Nutrition Program, operated by the Ministry of Education in collaboration with the Ministry of Health, to leverage infrastructure and financial resources for NTD-focused health education curriculum. Other projects in Malawi and Uganda have also contributed to reduced prevalence of blinding trachoma through increased uptake of hygiene and sanitation practices and strengthened capacity in planning, coordination, and monitoring of trachoma control programs.

As for the NNN, via the WASH Working Group we are currently surveying the community of practice to identify WASH and NTD research priorities, from WASH-related determinants of NTDs to implementation research for improved coordinated programming to evaluating impacts of such joint efforts. Plans to develop a technical resource on behaviour change are also underway. These are only some of the examples of how the NNN is promoting best practices for NTD elimination and control.

Your career has focused on developing cross-sectoral partnerships, which will be critical toward achieving the goals laid out in the WHO 2030 NTD Road Map. What challenges persist for WASH and NTD coordination, and what role do you see for the NNN in helping the NTD community overcome these barriers?

While WASH is critical to NTDs, current major WASH providers are not seen as NTD players as they are not participating in NTD control or elimination activities in most countries. There is also a lack of interest in partnership due to limited funding and capacity. Across countries, barriers in effective NTD-WASH coordination and collaboration include: 1) siloed program design and insufficient joint implementation; 2) limited advocacy and communication strategies on NTDs and missed opportunities to raise awareness of NTDs and their impact on public health and economic growth among WASH partners; 3) coordination mechanisms largely driven by donor funding and priorities; and 4) limited coordination and planning with relevant partners from the WASH, education, and health promotion sectors to leverage on their existing platforms to support NTD program activities.

Fortunately, The BEST framework–Behaviour, Environment, Social inclusion and Treatment and care–launched by the NNN in 2016, provides a guide for the NTD community in terms of advocacy messaging, coordinated action and funding. In addition, the NNN and WHO toolkit released last January in English and French, provides a number of tools for WASH and NTD practitioners to work better together. As it is Global Handwashing Day, I’ll emphasize two such tools: a resource on NTD-related behaviours and a guide to understand behaviours for developing behaviour change interventions. Addressing behaviour change is core to our efforts to beat NTDs, both in terms of prevention through hand and face washing, as well as the promotion of care-seeking behaviours.

COVID-19 has been immensely disruptive to many public health programs, including delaying mass drug administration activities. At the same time, however, it has also created unprecedented momentum for WASH. How is the NNN responding to this urgent need, while also strengthening coordination with the WASH sector to ‘build back better’ toward 2030?

Last month, the NNN convened its annual conference, the theme of which was building resilient NTD programs in a changing world. COVID-19 was but one focal point at the conference, during which attendees noted the resulting challenges, but also this opportunity to ‘build back better’ against future existential threats. WASH was a thread throughout the conference, including exceptional workshop sessions on behaviour change programming and evidence-based, cross-sectoral programming. The NNN, through the annual conference and monthly WASH Working Group meetings, provides a unique knowledge-sharing and action-based platform to strengthen coordination between WASH and NTD stakeholders.

Individual NNN members have also led the way on WASH and NTD coordination in response to COVID-19. The NALA Foundation, for example, with the support of The END Fund, is scaling up its WASH efforts in NTD-endemic areas to address both NTDs and COVID-19. This has included the construction and placement of 100 handwashing stations in public areas, including healthcare facilities. Additionally, several members recently pitched the Bill and Melinda Gates Foundation and other partners at the NTDs Idea Forum–launched at our recent NNN conference–on the opportunity to integrate WASH messaging and programming with COVID-19 and NTDs efforts.

World Vision has also leveraged its NTD partnerships to provide technical assistance to Ministries of Health, such as the Ghana Health Service/Ministry of Health (MOH/GHS) and the Senegal Ministry of Health and Social Action (MSAS), on their COVID-19 responses to enhance their cross-sector collaboration with WASH Ministries. In Ghana, the MOH/GHS is working with the Ministry of Sanitation and Water Resources and the Ministry of Education on policies, strategies, and programs for the provision of safe water sources, rehabilitation of environmental sanitation facilities, and dissemination of hygiene promotion messages. For instance, the Community Water and Sanitation Agency provided free water access to all Ghanaians in rural areas for 3 months to help stem the spread of COVID-19. In Senegal, the national response coordination platform for COVID-19 is led by the Centre des Operations d’Urgence Sanitaire mandated by MSAS. Implementing partners, including World Vision, constructed and rehabilitated WASH infrastructure and sensitized community actors at healthcare facilities, Daaras, mortuaries, and households on hygiene practices to reduce COVID-19 exposure and transmission.

To mark Global Handwashing Day this year, the NNN has issued a statement reaffirming and even expanding upon its commitment to WASH. What message do you want to send to the NTD community regarding hand hygiene for all?

The NNN is committed to hand hygiene for all and WASH more broadly as to sustainably eliminate and control NTDs. Our commitment to this issue covers political leadership for cross-cutting WASH and NTD policies, budgets and coordination mechanisms; an enabling environment that fosters collaboration between our sectors and a lively exchange of experiences and best practices; and, finally, sustainable, inclusive programming at scale through our work to develop technical resources and a research agenda for behaviour change interventions. The NTD community, including and beyond the NNN, has and will continue to be an effective partner to the WASH sector; however, as we look to the next decade and the Sustainable Development Agenda, it is evident that we must identify new and better ways to work more effectively together as to fast-track progress. I call on NNN members and the wider NTD community, including NTD-endemic countries, development partners, donors and the WHO, to prioritize critical WASH investments and interventions in NTD-endemic areas, reinforce hygiene behaviours for NTDs and promote joint leadership at the local and ministerial levels toward these ends. This collaboration is needed to achieve hand hygiene for all and a generation free from NTDs by 2030.

Maximizing Handwashing Behavior Change Through Multiple Community Engagement Tactics

15 October 2020 at 00:13

By: Sona Sharma and Armelle Sacher, Action Against Hunger

To promote hygienic behaviors, we must communicate and engage with communities across a variety of communication channels. In Uganda’s Kyangwali refugee settlement, Action Against Hunger’s social and behavior change efforts went beyond the simple dissemination of messages through multiple channels to also include specific tactics for enhanced engagement with communities. The efforts bore fruit, bringing about changes in handwashing behaviors.

Photo Credit: Sona Sharma, Action Against Hunger

Action Against Hunger, as a member of a project consortium supported by the European Union, aims to address immediate basic needs and increase resilience through an approach that puts people at its heart. Our efforts to improve access to clean water, safe sanitation, and good hygiene includes a variety of activites, including a ‘Cash for Latrine’ intervention and behavior change interventions to promote critical behaviors around handwashing, use of latrines, and safe disposal of child feces.

When the project began, just 43% of households in Kyangwali had handwashing facilities and only 32% of the household could list three critical moments for handwashing. Action Against Hunger conducted formative research to identify the main factors influencing hygiene behaviors in addition to the community’s preferred communication methods.

Based on our findings, we implemented a social and behavior change (SBC) strategy that included strategic engagement with communities through multiple platforms and channels, such as group sessions and home visits, community-based video shows and dialogues, drama shows, radio spots and talk shows, and rigorous follow up through hygiene promoters.

“The drama shows were very well done, and we learned that it is not good to use a latrine without a hand washing facility because the family members fell sick when they used the latrine and did not wash their hands after doing it.” – Caregiver for child under two years old

One unique aspect of this intervention was that every activity was planned in great detail to ensure it is connected with other activities for better recall, that there is two-way communication with communities and they are followed up to track behavior change. For example, a community-based participatory process was adopted, where community members, hygiene promoters, and local drama groups collaborated with professional actors and filmmakers to create and produce two video shows about handwashing and good hygiene. This tactic benefitted the video shows, since the audience related to known settings and were excited to see people they knew in the film. It also benefitted the drama shows as people recognized the actors from the film, thereby resulting in better engagement of the audiences.

“Videos taught us to use water and soap to wash hands when we are going to eat and that if we eat food without washing hands we shall get diseases as we saw on the video show” – Community Leader

The videos were screened in public venues and used to spark interactive discussion around hygiene. Every activity with the community members, whether a video show, a sensitization session or a drama show included interactions with people and ended with a request for commitments to adopt the promoted behaviors. Hygiene promoters then followed up on these commitments during their home visits. People from the community also participated in radio talk shows, by serving on panels or calling in to ask questions and clarify doubts.

Communities were not just passive recipients of messages, but active participants in every SBC activity. The results, within a short intervention time, reveal the potential of such a participatory approach.

In March 2020, a qualitative assessment of the effectiveness of the SBC component reported that project beneficiaries had very good knowledge of the five hygiene behaviors promoted through the intervention. The most prominent motivating factors for adoption of handwashing were the facts that handwashing prevents diseases such as cholera and Ebola and that families, especially those with young children, would be healthier with regular handwashing.

“Hand washing is easy because of the installation of the tippy tap and safe disposal of feces because I have a latrine.” – Mother of child under 5 years old

Photo Credit: Sona Sharma, Action Against Hunger

The video and radio shows had the ability to reach men, who are often left out from hygiene promotion activities. Additionally, many households had equipped themselves with simple home handwashing stations (tippy taps) and were regularly using them. Mothers, fathers, and other caregivers reported that handwashing was easy to practice, but that using soap was still a challenge as many people couldn’t afford it and the practice of handwashing before cooking was still not widely used. Finally, Action Against Hunger produced and shared guidance on radio programming, which continues to be used by partners to engage communities from a distance during the COVID-19 pandemic.

“It’s the hands that do everything in the home, and also it’s the hands that bring everything to the mouth, so hand washing is very important” – Mother of child under two years old

Several recommendations were made to improve the interventions, such as using music during the drama show to make it more attractive for a Congolese audience in the refugee camp; providing nylon rope for tippy taps, as ordinary rope often broke; equipping community leaders with radios to increase audience coverage; giving promotors tablets and speakers to show the video during door-to-door activities; and advising community members on how to prevent termite damage to tippy taps.

Action Against Hunger made a conscious effort to plan and synchronize our SBC activities to maximize overall impact. Activities were rolled out strategically, focusing on one topic at a time with simultaneous capacity-strengthening among hygiene promoters. With access to quality technical SBC support, trainings, and a detailed facilitation manual, the implementation team had every support they needed too.

In these difficult times, we know that promoting handwashing with soap is a dire necessity. We hope that these valuable lessons from our SBC intervention will lead to large-scale changes in handwashing behaviors.

How Eco-Soap Bank is tackling COVID-19 in partnership with the #Sweat4Soap Campaign

12 October 2020 at 22:08

By: Samir Lakhani, Eco-Soap Bank

Eco-Soap Bank, a global nonprofit organization employing women to recycle leftover soap from factories, and Mina Guli, a longstanding water advocate, are teaming up together to tackle COVID-19 and raise awareness about the newfound importance of handwashing with soap. Together, the partnership will donate 50,000 bars of soap to schools this week in 5 developing countries.

Right now, we’re washing our hands, our clothes and the surfaces around our home more than ever. For most of us, the process is relatively straightforward – we do it without a second thought: tap on, hands underneath, apply soap and sing happy birthday while we scrub.

But for the 3 billion people on our planet that don’t have access to adequate handwashing facilities, it’s a very different story.

The world is in the midst of a global COVID-19 pandemic that is threatening to destroy the life and health of vulnerable groups and devastate the economies of the developing world.

After months of lockdowns intended to contain and mitigate the spread and effects of the deadly COVID-19 virus, the developing world is now beginning to reopen its schools. This new phase is fraught with risk, especially in the developing world where resources are few and children and elderly people often live close together in the same household.

To prevent further escalation of the COVID-19 pandemic, it is crucial that as many as possible of these reopening schools are provided with basic access to soap and handwashing education. Handwashing with soap constitutes the most cost-effective method to combat the detrimental effects of COVID-19 and other hygiene-related illnesses, but lacking soap availability and hygiene awareness represents a significant obstacle to current mitigation efforts.

The #Sweat4Soap campaign is simple and lifesaving: for every kilometer that is run or walked from October 10-17, 2020 using the hashtag #Sweat4Soap, a bar of soap will be donated to a community in need. Participants have already logged 5,500 kms equaling 5,500 bars of soap! So grab your running or walking shoes and #Sweat4Soap to save lives!

About Eco-Soap Bank

Eco-Soap Bank employs disadvantaged women worldwide to recycle leftover soap from hotels and factories and redistributes it to impoverished communities along with hygiene education to reduce disease and save lives.

To date, the organization employs 154 women who have provided more than 9 million bars of soap and education to over 3 million people in 15 developing countries, supporting over 2,500 schools, health clinics, and refugee settlements.

Eco-Soap Bank and Soap Manufacturers

Eco-Soap Bank maintains a diversified recycling and sourcing strategy through partnerships with medium-sized and large global FMCGs, which generate millions of bars of usable discarded soap each year. We collect those waste volumes and help these companies become zero-waste manufacturers and achieve their social impact goals. Since January 2020, we’ve sourced 400 metric tons of soap waste—and we estimate that we’re currently collecting only a small fraction of the global volume of waste. Please get in touch to collaborate to recycle surplus soap and save lives: samir@ecosoapbank.org.

COVID-19 as an awakening for hand hygiene access

13 October 2020 at 12:09

By: Team DefeatDD

In the time of COVID, the future is in our hands. Literally. Photo: PATH/Gareth Bentley

When the COVID-19 pandemic first began and little was known about the novel coronavirus, one of the World Health Organization (WHO)’s first recommendations was a simple, tried-and-true public health measure: handwashing. This advice persists today as one of the most important ways, alongside masks, to prevent COVID-19. Just twenty seconds of scrubbing with water and soap, or with an alcohol-based hand sanitizer, can wash away the novel coronavirus—in addition to other common infectious diseases such as typhoid, cholera, and diarrheal pathogens like rotavirus, E. coli, and Shigella.

As the pandemic unfolded around the world, hand sanitizer and handwashing stations became as in-demand as toilet paper. But in too many places around the world, a preexisting lack of access to safe water, sanitation, and hygiene (WASH) resources makes handwashing impossible. In fact, 40% of the world’s population does not have access to a basic handwashing facility.

For health care workers who cannot practice safe handwashing due to a lack of safe water or soap in health care facilities, this issue can have dire consequences for spreading infection. In a COVID-19 guidance document sent to Member States in April 2020, WHO wrote:

“Although awareness of the importance of hand hygiene in preventing infection with the COVID-19 virus is high, access to hand hygiene facilities that include alcohol-based hand rubs as well as soap and water is often suboptimal in the community and in health care facility settings, especially in low-and middle-income countries. WHO and UNICEF estimate that globally 3 billion people lack hand hygiene facilities at home and two out of five health care facilities lack hand hygiene at points of care.

WHO recognized WASH in health care facilities as an urgent global health crisis in 2019, before COVID-19 began. The World Health Assembly Resolution urges countries to address the issue and seeks commitments from governments, partners, organizations, and individuals in line with the Resolution.

Another critical location for hand hygiene access is in schools. For families without handwashing facilities at home, schools can be a lifeline of hygiene access for children. With many schools currently closed due to the pandemic, this lifeline is shut off. But in too many other schools, WASH was already lacking before the start of COVID-19.  A recent WASH in Schools report from UNICEF found that, in the 60 countries at the highest risk of health and humanitarian crisis due to COVID-19, 3 in 4 children lacked a basic handwashing service at their school at the start of the outbreak. As schools begin to reopen, UNICEF and WHO urge governments to implement WASH in schools. These steps will not only help stop the spread of COVID-19, but also protect children from other WASH-related diseases such as diarrhea and typhoid that can interrupt education and have lasting health consequences.

Of course, installing handwashing facilities is just the first step to improving access and uptake. As with all public health interventions, there also is a human behavioral component. The latest research on behavior change highlights the utility of simple environmental “nudges” such as signs, communication that is empowering rather than fear-inducing, and the importance of infrastructure. More behavior change research is needed, but one thing is clear—behavior change can only go so far without policy change. It’s impossible for people to make good choices when they have no good choices. In the same COVID-19 guidance document, WHO acknowledges findings from research:

“When hand hygiene is provided free of charge and is made obligatory by public health authorities, acceptability and adherence to hand hygiene best practices are improved.”

In order to make access to hand hygiene a universal reality, it is crucial for country governments to support hand hygiene through policies and funding: something that WHO and UNICEF formally called for in their Hand Hygiene for All call to action. The pandemic makes this call especially urgent, but long before COVID-19, the everyday crises of cholera, pneumonia, typhoid, and diarrheal diseases revealed the consequences of inadequate WASH in homes, schools, and health care facilities. We’ve learned a lot from the efforts to combat these diseases and their cascading impacts, so we know what needs to be done.

Perhaps COVID-19 can serve as the wake-up call to prioritize hand hygiene—along with safe water and sanitation—now and long into the future.

WASH practitioners stand on the frontline of Nigeria’s COVID-19 response

16 July 2020 at 21:39

By: Olajide Adelana

This article was originally posted on WSSCC’s website. 

ABUJA, Nigeria – The role of water, sanitation and hygiene (WASH) practitioners in Nigeria’s response to the COVID-19 pandemic cannot be overemphasized as working on the front line of the fight against the coronavirus requires both courage and commitment.

Mr Benson Attah, National Coordinator of the Society for Water and Sanitation (NEWSAN) – an umbrella body for civil society organizations (CSOs) working in the WASH sector – is a WASH practitioner, whose commitment has been unwavering in implementing and monitoring Nigeria’s COVID-19 response framework.

When Mr Attah heard about the number of COVID-19 cases in the country, his first action was to alert NEWSAN’s state chapters to immediately commence community sensitization and ensure compliance with the safety protocols of the World Health Organization and Nigeria Centre for Disease Control (NCDC). With his colleagues at NEWSAN, Mr Attah also created an action plan for the pandemic at various state levels, which became a vital tool for awareness creation and COVID-19 prevention activities at the community level.

“The COVID-19 pandemic didn’t come as a surprise and my experience with professional emergency management equipped me for this type of emergency,” he says. “We had thought the N1H1 virus between 2008 and 2009 was going to be a pandemic but it was not. It was just a matter of time.

Nigeria’s coronavirus cases have begun to soar with no less than 29,286 laboratory confirmed cases as of 7 July 2020. Mr Attah states that the ongoing community spread of the disease is concerning, but more worrisome are Nigeria’s hygiene and sanitation statistics.

According to the 2018 WASH Norm Survey findings by Nigeria’s Federal Ministry of Water Resources, only 11 percent of the entire population has access to complete basic water, sanitation and hygiene services. 16 percent of schools have basic water and sanitation services, and 47 million people still practice open defecation.

Mr Attah explains that these statistics expose worrying gaps both in light of COVID-19 safety protocol’s insistence on personal hygiene and Nigeria’s growing population, which is currently estimated at 200 million people.

Also of significant concern is the impact of these statistics on rural and hard-to-reach communities in Nigeria, where the likelihood of misinformation about the disease is high and medical interventions can be challenging.

The pandemic has overstretched Nigeria’s already weak healthcare sector, which suffers from a shortage of manpower and equipment, requiring many to step in as frontline workers to support the fight against the virus.  Despite the challenges, Mr Attah, who is a member of Nigeria’s Federal Capital Territory’s COVID-19 task force team, says he is not scared to be on the frontline.

I would not be part of the team if I was scared. I keep myself safe and sane by making sure that I don’t compromise my safety and I religiously follow preventive protocols.

WSSCC has been providing support to the Nigerian government in response to the pandemic by tailoring one of its flagship initiatives, Rural Sanitation and Hygiene Programme in Nigeria (RUSHPIN), and supporting organizations like NEWSAN to address COVID-19 related issues.

RUSHPIN has been effective in breaking down scientific information into graspable formats, and debunking myths concerning COVID-19, sanitation and hygiene in rural and hard to reach areas in Nigeria. Meanwhile, NEWSAN has continued to provide necessary administrative support to the Nigerian government down to the State and Local Government levels.

Coronavirus brings several points of reflection for WASH experts in Nigeria.

“In NEWSAN, we have always regarded WASH as the ‘gateway to development’ as it affects every aspect of development, health, education, economy, labour and productivity. In Nigeria, the WASH sector should be more professional in its set up and outlook,” explains Mr Attah.

“Government across different levels should take immediate responsibility by recognizing the prominent role of the WASH CSOs in ensuring that coronavirus does not spread beyond its present point and, this should be allowed to gradually transit and consolidate into an all-round development that is sustainable.”

Sustaining Sanitation and Hygiene in Madagascar: the Impact of the Pandemic

14 July 2020 at 21:28

By: Hoby Randrianimanana

This interview was originally posted on WSSCC’s website. 

ANTANANARIVO, Madagascar – Dr Fano Randriamanantsoa is the Community Mobilization Specialist at the Fonds d’Appui pour l’Assainissement (FAA), WSSCC’s Global Sanitation Fund programme in Madagascar.

A medical doctor by training, Fano Randriamanantsoa has worked in the WASH sector for over ten years. His role with FAA is to coordinate and monitor sanitation and hygiene activities in communities that have been declared open defecation-free (post-ODF activities). He spoke with us on how his work has been impacted by COVID-19.

WSSCC: Could you tell us about your work?

Dr Fano Randriamanantsoa, Community Mobilization Specialist at the Fonds d’Appui pour l’Assainissement: I coordinate and monitor the post-ODF activities of the implementing agencies we fund. For that, I first define specialities needed to support these agencies in their post-ODF activities, and then I recruit consultants for each speciality, including, among others, sanitation marketing, capacity building and Village Saving and Loan Association (VSLA) expertise.

A key aspect of my work is going in the field to collect feedback, learn and share knowledge, and test with partners the approaches we have developed.

According to WSSCC’s “EQND” handbook, post-ODF activities refers to any structured activity taking place in a community after they have been certified as ODF, with objectives ranging from sustaining changed sanitation and hygiene behaviour to promoting the use of more hygienic and sustainable facilities and addressing other aspects of environmental hygiene, including safe water treatment and solid waste management.

WSSCC: Based on your experience, what are some of the challenges to sustainability for ODF communities in Madagascar?

Dr Randriamanantsoa: I can give four prevailing challenges in our work:

Behavioural challenges arise when residents are not fully convinced that they don’t want to eat “shit” anymore. It is the result of using the wrong approach. Implementers often tend to be either too strict or too easygoing. Sometimes, they get too involved in the community, preventing the population from taking full responsibility for improving their own sanitation and hygiene.

Economic hardship is a challenge we often encounter in the field, where the majority live on less than 2 dollars a day. It automatically excludes the poorest as they are unable to afford even the most basic sanitation and hygiene services.

Non-access to resilient and sustainable infrastructure is tied to economic hardship. Due to limited resources, communities cannot build durable facilities and instead resort to using cheaper local materials, which are not sustainable and tend to become non-functional either because of weather conditions or overuse.

Environmental challenge includes external factors that aren’t necessarily sanitation and hygiene-related but potentially affect them, such as weather conditions, soil type, political atmosphere, unsupportive local leaders, and crowd-gathering cultural events.

WSSCC: When communities are having difficulty sustaining their ODF status, what support does the programme provide to address the situation?

Dr Randriamanantsoa: We have seen many cases of slippage over the years, and what we do is provide implementing agencies with tools and approaches to tackle them.

For instance, when a community is experiencing slippage due to behavioural issues, we facilitate the establishment of the Local Community Governance (GLC), where residents are trained in methods to uphold changed behaviours. Where it is caused by economic hardship, we guide the agencies in the creation of a VSLA to help community members, especially the poorest, maintain or upgrade their facilities.

As for slippage originating from non-resilient infrastructure, we encourage agencies to promote sanitation marketing with local technicians, who have been trained to build durable latrines.

Slippage is used to describe the return to previous unhygienic behaviours due to the inability of some or all community members to continue to meet all ODF criteria.

WSSCC: Again, based on your experience, can you talk about the difference between working in rural areas and sub-urban/urban areas?

Dr Randriamanantsoa: We have seen that working in rural areas is more productive thanks mainly to our ability to use what is called continuum community-led total sanitation (CLTS) —implemented from the beginning until long after ODF certification—without any disruption.

CLTS is more effective in rural areas because of existing socio-cultural norms such as tight-knit communities, respect for elders and handcrafting skills. Most rural communities are also more open to innovations from outside as long as those innovations don’t contradict their values. On the contrary, the closer you move to urban settings, the more challenging post-ODF work becomes. We usually combine various approaches in these areas and sometimes request the help of other partners to carry out activities.

WSSCC: How has COVID-19 affected your post-ODF activity programming?

Dr Randriamanantsoa: Because of the lockdown, we have suspended most activities in our 19,000 ODF-certified communities. We have, however, a few implementing agencies carrying out post-ODF activities while adhering to COVID-19 prevention rules. In other cases, the agencies follow up remotely by connecting with members of Local Community Governance (GLC) and Local Institution Governance (GLI).

In Nigeria, Doctors Turn to Basic Hygiene to Slow Covid-19

3 July 2020 at 21:50

By: Elena Bruess

As the coronavirus pandemic spreads through Africa’s most populous country, a health foundation pushes for better access to water, sanitation and hygiene.

Members of Wellbeing Foundation Africa speaking about their Clean Hands for All initiative © Wellbeing Foundation Africa

Otun Adewale recounts the story of two doctors in a private hospital in Abuja, Nigeria. One who washes his hands after he is with a patient, the other who does not. One who contracts Covid-19 and one who does not.

Adewale is a senior medical officer in maternal and child health. Since the beginning of the year, the doctor has been working with Wellbeing Foundation Africa (WBFA), an organization that focuses on women’s and children’s health in Nigeria through education, advocacy, and better care. For the past few months, Adewale and the team at WBFA have had a new mission: breaking the transmission of Covid-19 by improving water, sanitation, and hygiene practices.

“This story actually got me interested,” Adewale told Circle of Blue, referring to the parable of the two doctors. “That as simple as handwashing can be, as simple as observing these precautionary measures can be, it can actually save you from the dangers of Covid-19. The other person who takes it for levity is facing the music now.”

Members of Wellbeing Foundation Africa present clean water for handwashing. Photo © Wellbeing Foundation Africa

Though it had a late start, the disease is spreading through Nigeria with increasing speed. As of June 30, Nigeria had more than 25,000 confirmed Covid-19 cases, the second highest number in Africa. Forty percent of the cases were recorded in the last two weeks. Vulnerable populations such as frontline healthcare workers are at a greater risk without proper water or hygiene.

That is where organizations like WBFA step in. The foundation notes that hospitals and clinics often have inadequate water supplies and lack soap to prevent disease transmission. According to Rita Momoh, a midwife with WBFA, expecting mothers might be scared doctors will bring Covid-19 to their homes when they have a checkup, or the mothers may not be comfortable going to the healthcare facility when they need to.

“The atmosphere surrounding handwashing and personal hygiene in response to Covid-19 [in Nigeria] can be rated very, very low.” Adewale explained. “A majority of Nigeria still believes Covid-19 isn’t real. Some believe it is a scam.” He added: “People will only take responsibility for their health when they are convinced of Covid-19.”

‘It All Comes Back to WASH’

A leading organization for water, sanitation, and hygiene before Covid-19, the foundation has since intensified its educational outreach due to the virus. WBFA workers teach classes to healthcare facility employees and engage with hospital officials to install handwashing stations. The foundation holds meetings with community leaders and passes out flyers in the local language so residents can understand and value the information. WBFA also has a virtual program for adolescents across states, to educate and demonstrate how to wash.

Most rural communities do not have easy access to clean water, and residents will often travel long distances to find wells or creeks. Urban Nigeria has better water and sanitation access rates than rural areas, yet cities face their own challenges with the virus. The expansion of unplanned settlements such as slums puts more lives at risk because of crowded living conditions and inadequate water, sanitation, and hygiene, known collectively by their acronym WASH.

A member of Wellbeing Foundation Africa speaks with villagers about WASH and Covid-19. Photo © Wellbeing Foundation Africa.

According to WaterAid, 57 million people in Nigeria do not have access to clean water, and 130 million do not have basic sanitation or hygiene. This is in a country of about 200 million people. Nigeria operates as a federation of 36 states, each with a different institutional framework. The fragmentation has its drawbacks. According to Alero Roberts at WBFA, the water board that is responsible for clean water and sanitation in every state is often aging and ineffective.

“What this pandemic has taught us is how easily our health system can be stretched beyond capacity,” Roberts told Circle of Blue. “We’re talking infection prevention and control, but with infection prevention and control we’re talking water and sanitation hygiene. It all comes back to WASH.”

For now, WBFA will continue to educate individuals and advocate for healthcare adaptation in Nigeria. So when a patient needs a checkup, there’s no doubt about handwashing and proper procedures.

“Because what we need to do is change hearts and minds,” Roberts said.


How I Found My Way to Advocating for Safe Water and Sanitation in Nigeria and Beyond

23 June 2020 at 22:37

By: Her Excellency Toyin Saraki, founder-president of Wellbeing Foundation Africa

This article was originally posted on Global Citizen. 

In African traditional folklore, we have a proverb: “Every dance starts with a clap.” Just watch us and you’ll find this proverb is indeed true. We clap at least once from a primordial pre-instinct, to find our rhythm and set the tone, before we begin to dip, sway, and swirl.

But we have another African proverb that says, “You cannot clap with one hand.” And so I embarked on clapping with two hands, advocating on behalf of women, girls, and children around the world.

In hindsight, the roots of my global work are found in my baby’s nursery. I was expecting twins but tragically, only one child would survive. I returned home with my new baby daughter and replicated in the nursery what I had seen in the neonatal intensive care unit. I quickly had water pipes installed so her nursery would have a handwashing basin just inside by the door. I knew for my newborn to be safe, I needed two clean hands.

In 2003, I became a very young and very new First Lady to the north-central Nigerian state of Kwara, where my husband was elected governor. I took time to get to know the people, their needs, and the basic services that existed for Kwara’s 3 million inhabitants. I would visit dilapidated hospitals and schools, untouched since 1974. Whenever I wanted to shake hands or hold a baby, and wished to wash my hands, water was not available and there was invariably a 10-minute or more delay while someone would have to fetch a bowl of water from a well, borehole, or tank.

Photo Credit: Wellbeing Foundation Africa

I continue to encounter the inability to wash hands in places of critical care. In April 2018, I visited my Wellbeing Foundation Africa’s MamaCare Midwives Antenatal and Postnatal Session at a Primary Health Care Centre in Abuja, Nigeria’s capital. I was there to encourage mothers to allow their infants to receive oral polio vaccinations during World Immunisation Week. When I asked to wash my hands, I again faced that delay while a bucket of water was fetched.

At home that evening, I looked into current data and found that only 5% of health facilities in Nigeria have combined basic water, sanitation, and hygiene (WASH) services. The absence of WASH during birth plagues 17 million women across least-developed countries every year. It is clear that we are still trying to clap with one hand.

Now the need for two clean hands is being recognized as more urgent than ever — and perhaps that’s the only good news to come from the coronavirus pandemic. The handwashing that the WASH community has so long advocated for has come out of its echo chamber, and become a thunderous resounding clap for global health.

COVID-19 has made “wash your hands” a daily adage and has reinforced the need to invest in safe and dignified health care. This renewed urgency calls us to ensure that the WASH and health communities unite indivisibly to activate, actualise, and accelerate WASH investments to match the behavioural change.

Image: Courtesy of Wellbeing Foundation Africa

I see this need in my country. Despite the slower pace of COVID-19 across the African continent, Nigeria’s eventual burden could be one of the worst in Africa. Reality on the ground is showing weak health systems already stretched to a breaking point, according to reports from medical and public health officials.

Valuable programs are gaining needed steam, like WaterAid’s “Clean Nigeria” campaign for homes and hospitals, and the London School of Hygiene & Tropical Medicine’s global “Teach Clean” campaign, to achieve infection prevention and control, and prevent maternal and newborn sepsis.

Our midwives persevere. As our “WASH for Wellbeing” midwives work every day, teaching over 8,000 young pregnant and nursing mothers and their medical colleagues in hundreds of health facilities, they are my frontline warriors for WASH. Too often, the photos they send me still show a water tank in the far distance, and a bucket of water on a table.

In this inaugural UN Year of the Nurse and Midwife, we must ensure that health care workers everywhere have access to WASH. Hands, all around the world, are working tirelessly. Let’s be sure they can do so, safely.

Join the momentum tomorrow! From the mountains for Nepal to leadership at USAID, Water.org, the Vatican, and funders:  

About the Author

As Founder-President of Wellbeing Foundation Africa (WBFA), Mrs Toyin Saraki is a Nigerian philanthropist with two decades of advocacy covering maternal, newborn and child health, gender-based discrimination and violence, improving education, socio-economic empowerment and community livelihoods in Africa.

Without WASH, Health Workers Can’t Do Their Jobs

16 June 2020 at 20:11

By: Lindsay Denny, Global Water 2020

This post was originally posted as a Frontline Health Workers Coalition blog. 

The hospital—a referral hospital in Bahir Day, Ethiopia—served a population of 25 million. Dozens of mothers gave birth daily, some of whom were sent from other facilities in order to deliver by emergency Cesarean section. It was a bustling institution, yet it was without some of the most basic amenities—I saw broken water taps, unsanitary toilets, and no soap or other supplies for cleaning. The nurses of the neonatal intensive care unit, where there were no sinks for handwashing, recognized what the conditions meant. Their job is to care for the most vulnerable, yet they were unable to drop the spread of infection within their unit.

The neonatal intensive care unit at the referral hospital in Ethiopia lacked soap and water for health workers to wash their hands. Photo courtesy of Lindsay Denny.

This hospital isn’t the exception in low- and middle-income countries. According to a recent report from WHO and UNICEF, two billion people must rely on health facilities that lack basic water services and 1.5 billion people visit facilities without toilets. Without these basic amenities, it is impossible to provide safe care and live up to the doctrine of “do not harm.”

Nearly 1 in 6 patients in developing countries acquires an infection inside a health facility. Handwashing alone can cut deadly diarrheal disease by 45%, but not if hands cannot be washed due to inadequate soap and water, or if hygiene behaviors are not fully adopted. Some 61% of health workers do not adhere to recommended hand hygiene practices. Hygiene behavior change is needed. As is soap and water.

Learn about WASH in health care facilities during a virtual event on June 24, 2020.

The lack of water, sanitation and hygiene (WASH) services also endangers health workers. Consider the 2014 Ebola outbreak. Ebola not only killed some 11,000 people, it was 103-fold higher in health workers in Sierra Leone than in the general population, 42-fold higher in Guinea health workers, and Liberia lost 8% of its health workforce. These losses were in part due to that fact that health workers did not have access to adequate WASH. The situation has not improved. In the Democratic Republic of the Congo, where Ebola killed thousands, 50% of facilities have no water, 59% have no toilets, and just 62% have soap and water or hand sanitizer at points of care. Now global health care staff addressing COVID-19 face similar challenges and threats. Additionally, given that the majority of midwives, nurses, and cleaners are women, the lack of WASH disproportionately affects women. For example, without proper toilets, female health workers may be forced to hold their bladders through their shifts—a recipe for a urinary tract infection.

This problem of WASH in the health facility has long been neglected, but it is solvable and momentum is building. UN Secretary-General António Guterres issued a global Call to Action in 2018 to get WASH into health facilities; WHO Member States then unanimously adopted in a 2019 World Health Assembly Resolution that includes eight practical steps towards successful implementation by 2030. WHO and UNICEF responded with metrics to chart progress by governments, and dozens of national governments are now exploring concrete plans and resource requirements. In 2020, WHO prioritized the absence of WASH in HCFs as among the most urgent global health challenges in the coming decade for the first time.

Last June, 92 diverse organizations announced commitments to WASH in health facilities. In the past year, these organizations have been translating commitments into action. At the same time, the COVID-19 pandemic has brought the global need into even sharper focus. Now more than ever, WASH in health facilities must be a foremost priority for governments, funders, and development assistance organizations alike. Progress demands an adequate level of support for sustainable, and accountable, WASH services in health facilities, regularly monitored by professional authorities.

On June 24, 2020, Global Water 2020 and Global Health Council are hosting a virtual event recognizing the first anniversary of these commitments. Global health and WASH leaders will come together to reflect on efforts to reach every health facility with WASH services. We urge our global health colleagues, in particular those working on the front lines of health care delivery, to join the discussion. It is critical that we continue to drive progress towards WASH in all health facilities, everywhere. And in the process, we must elevate the voices of frontline health workers, for whom this deficit has the greatest impact.

NGO provides sanitary pads to girls in Nairobi slum during COVID-19 lockdown

16 June 2020 at 20:06

By: Kevin Mwanza

This post was originally posted on WSSCC’s website. 

NAIROBI, Kenya – In Nairobi’s Korogocho slums, the sudden closure of schools in March was a double tragedy for 15-year-old Consolata. It meant she would lose out not only on learning, but also on free access to sanitary towels provided under a government scheme to promote menstrual health and hygiene.

As the global lockdown occasioned by COVID-19 has forced people to stay home and live on reduced income, she and millions of girls around the world who live in informal setlements are struggling to access sanitary pads.

The form-two student says she is lucky to get menstrual pads from a local non-governmental organization known as Miss Koch that empowers young girls and women in Korogocho slums.

“We can’t access these (government) pads until we go back to school. Our mum cannot afford to buy us pads and also provide for food. So we mostly depend on what Miss Koch provides,” Consolata said.

“We are five girls in our house, and the pads are usually not enough for all of us. Sometimes we ask our brothers to chip in.”

The Kenyan government, through the State Department for Gender Affairs, runs a programme to provide free sanitary towels to some 3.7 million girls in public primary schools, special primary and secondary schools in the country.

The scheme is essential in a country where over 65% of people who menstruate cannot afford sanitary towels, according to figures cited in the 2016 report Menstrual Health in Kenya, published by non-profit consulting firm FSG.

It also showed that 6 out of 10 girls in Kenya had never heard about menstruation until their first period.

The government-funded sanitary towel program was initiated in 2011 and has so far benefited over 11.2 million girls, mostly in marginalised and slum areas, according to the ministry.  The closure of schools in March due to COVID-19 halted pad distribution.


Consolata is one of 600 children in Korogocho slum that benefit from a mentorship programme by Miss Koch that seeks to support child-parent relationships, said Emmie Erondanga, the organization’s executive director.

The NGO also distributes sanitary towels donated by well-wishers to girls through private and apex schools within the informal settlements that do not benefit from the state scheme.

“But with COVID-19, things have changed. Schools closed abruptly and these girls are out of school,” Erondanga said.

“Sometimes we get short of supplies, which means the girls that we have not reached will go for alternative avenues. These could lead to dropping out of school or even teenage pregnancies.”

According to a UNESCO report, Puberty Education & Menstrual Hygiene Management, one in ten girls in sub-Sahara Africa misses school during their periods, losing up to 20 school days a year and increasing their chance of dropping out altogether.

Patricia, one of Consolata’s four sisters, says that while she benefited from the free sanitary pads while in school, it has become harder to afford them after she finished her secondary school education in 2019.

“Sometimes we have to use rags or borrow from friends,” Patricia said.

“Girls here end up having sex with men so that they can get money to buy pads. Some of my friends have even ended up pregnant just because they could not afford pads.”

Inadequate knowledge of sexual and reproductive health among adolescents has meant that over 3.9 million school-going girls aged between 15 and 19 undergo unsafe abortions annually, according to the World Health Organization.

For Consolata and girls and women across the country, there is hope for more robust support as they continue to face their menstrual challenges. On this year’s Menstrual Hygiene Day (28 May), the Government of Kenya launchd a landmark stand-alone policy dedicated to menstrual health and hygiene.

The Menstrual Hygiene policy 2019-30 will create an enabling environment for implementation of menstrual hygiene and management interventions in Kenya. It will also ensure women and girls have access to safe and hygienic products.