Washing your hands with soap and water seems simple enough, but it can have a huge impact on personal and public health. It is an effective and inexpensive way to help prevent transmission of diseases such as diarrheal and respiratory infections. UNICEF estimates that children can reduce their risk of getting diarrhea by more than 40% by handwashing with soap. As a standard hygiene measure to prevent infections, including the new coronavirus, WHO also advises the general public to practice handwashing with soap and water.
Handwashing is now recognized as a top hygiene priority and is monitored as part of Sustainable Development Goal 6 (indicator 6.2). The WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) has defined handwashing facilities with soap and water at home as basic handwashing facilities and has estimated the population with access. Some people might take these for granted, but there are still many who don’t have basic handwashing facilities at home, especially in low- and lower middle-income countries. Let’s explore some of the challenges to maintaining good hand hygiene:
Level of access to handwashing facilities
The most recent data (2017) estimating the availability of handwashing facilities at home are available for 77 countries and are based primarily on household surveys such as Multiple Indicator Cluster Surveys and Demographic and Health Surveys. In these surveys, the enumerator visits the handwashing facility and observes if water and soap are present. In 42 countries (54% of the countries with data), less than half of the population don’t have basic handwashing facilities with soap and water in their homes. The countries with low access are concentrated in Sub-Saharan Africa. For example, Liberia, Lesotho, Democratic Republic of Congo and Rwanda have especially low level of access (less than 5%). Outside Sub-Saharan Africa, in Haiti, Vanuatu, Bolivia, and Timor-Leste less than 30% of people have basic handwashing facilities where they live. In the countries with the low access, not only installation of handwashing facilities with running water but also behavioral change may need to be promoted. UNICEF points out that soaps are available in low-income countries, but rarely used for handwashing.
Handwashing at key times
Washing your hands frequently, and particularly at key times such as before eating and after coughing, is important to remove bacteria and viruses and to protect personal health and that of those around. Washing hands after using the toilet is critical as human feces are the source of germs like salmonella or norovirus. However, many households are still not able to do so. In seven countries (Rwanda, Eswatini, Senegal, Bolivia, Timor-Leste, South Africa and Nepal), more than half of households have at least basic sanitation facilities (that include toilets without flush system), but less than half households have basic handwashing facilities at home. For example, in Rwanda, 67% of people have access to at least basic sanitation facilities, or toilets, but less than 5% have basic handwashing facilities at home.
Who are the people least likely to access basic handwashing facilities?
Those living in rural areas are generally more disadvantaged when it comes to accessing basic handwashing facilities than people living in urban areas. For example, in Columbia, the population in urban areas has twice as much access as the population in rural areas (73 % and 35% respectively).
Likewise, people from poorest households are less likely to have access to basic handwashing facilities at home. In some countries, the access gaps between poorest and richest households are stark. In Pakistan, while 94% of people from richest households have basic handwashing facilities at home only 17% of people from the poorest households do. In Afghanistan, Chad, Eswatini and Gambia, people from very poor households do not have basic handwashing facilities.
Notes on the data:
Monitoring and measuring handwashing behavior can be challenging. Presence of a handwashing station with soap and water does not guarantee that household members consistently wash hands at key times, but JMP states that observation of handwashing materials by surveyors represents a more reliable proxy for handwashing behavior than asking individuals whether they wash their hands. Also, the data in most high-income countries are not available as it is assumed that basic handwashing facilities are nearly universal.
Definition of the indicators:
People with basic handwashing facilities including soap and water (% of population) The percentage of people living in households that have a handwashing facility with soap and water available on the premises. Handwashing facilities may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. Soap includes bar soap, liquid soap, powder detergent, and soapy water but does not include ash, soil, sand or other handwashing agents.
People using at least basic sanitation services (% of population) The percentage of people using improved sanitation facilities that are not shared with other households. This indicator encompasses both people using basic sanitation services as well as those using safely managed sanitation services. Improved sanitation facilities include flush/pour flush to piped sewer systems, septic tanks or pit latrines; ventilated improved pit latrines, compositing toilets or pit latrines with slabs.