Hand hygiene, a public policy issue

Interventions to promote hand hygiene should be designed based on an understanding of what people care about, says report on ‘State of the world’s hand hygiene’
15 Oct 2021
0 mins read
Girls learn the value of hand-washing (Image: Kristen Kelleher, USAID, Pixnio)
Girls learn the value of hand-washing (Image: Kristen Kelleher, USAID, Pixnio)

The simple act of cleaning hands can save lives and reduce illness by helping prevent the spread of infectious diseases. The benefits of hand hygiene in preventing the transmission of infectious diseases have been known since 1850. For example, proper hand hygiene has been proven to reduce deaths from respiratory and diarrheal diseases in children under five by 21 per cent and 30 per cent respectively.

Yet in 2021, an estimated 2.3 billion people globally cannot wash their hands with soap and water at home and one-third of the world’s health facilities lack hand hygiene resources at the point of care. Meanwhile, nearly half of schools worldwide do not have basic hygiene services, affecting 817 million children.

Over the past five years, half a billion people have gained access to basic hand hygiene facilities – a rate of 300,000 per day. This is progress, but it is far too slow. Both access to the facilities to practice hand hygiene and support for the behaviours required are missing in many settings.

At the current rate, almost two billion people will still lack access to basic hand hygiene facilities in 2030, negatively impacting other development priorities, including education, health, nutrition, and economic growth. Despite efforts to promote hand hygiene, the rates of access to hand hygiene facilities remain stubbornly low.

During the COVID-19 pandemic, hand hygiene received unprecedented attention and became a central pillar in national COVID prevention strategies. However, concern with hand hygiene should not only be as a temporary public health measure in times of crisis but as a vital everyday behaviour that contributes to the health and economic resilience. Hand hygiene is a highly cost-effective investment, providing outsized health benefits for relatively little cost.

“Many of those who have had to get through this pandemic without basic handwashing facilities are also in places that have struggled with lower, slower access to vaccines, therapeutics and testing resources, not to mention battling other, preventable infections — a triple burden,” said Dr Maria Neira, Director of the Department of Environment, Climate Change and Health at WHO.

“Ramping up action to ensure universal access to hand hygiene facilities is one clear example of the complementarity of getting out of the pandemic, preparing for the next one, and meeting the Sustainable Development Goals — and it is certainly a requirement of universal health coverage,” she adds.

In 2020, UNICEF, WHO and other partners launched the Hand Hygiene for All initiative, with the aim of channelling momentum around hand hygiene into long-term sustainable change.

This report ‘State of the World’s Hand Hygiene: A global call to action to make hand hygiene a priority in policy and practice’ by the World Health Organisation (WHO) and United Nations Children Fund (UNICEF) outlines the current state of hand hygiene in the world, and how governments, communities, individuals and other stakeholders can accelerate progress to achieve hand hygiene for all.

This report is the first of its kind and brings together various data sets to present the current status of hand hygiene, highlight lagging progress, and call governments and supporting agencies to action, offering numerous inspiring examples of change.

“Hand hygiene is a truly ‘no-regrets’ investment — our estimates show that for every dollar invested, countries can save $15. But the rates of access to hand hygiene facilities remain stubbornly low. With some notable exceptions, few countries have made significant efforts to tackle the need for hand hygiene in public places, for example,” said Bruce Gordon, Head of the Water, Sanitation and Hygiene Unit at WHO “Governments should commit to hand hygiene not just as a temporary public health intervention in times of crisis, but as a vital everyday behaviour that contributes to health and economic resilience.”

This report presents a compelling case for investment in five key ‘accelerators’ as a pathway towards achieving hand hygiene for all – governance, financing, capacity development, data and information, and innovation. These accelerators are identified under the UN-Water SDG 6 Global Acceleration Framework.

Good governance begins with leadership, effective coordination and regulation

It is critical that governments establish clear policies relating to both service availability that facilitates handwashing, including readily available water, and the behaviours required to ensure hand hygiene is common practice in all relevant settings.

Hand hygiene should be championed – by a head of state, minister or another senior political figure ready to assume the challenge of driving progress. Local leadership is equally important; states, districts and villages should also be committed. All levels of government need to be clear that hand hygiene is a crucial public policy issue, and progress requires targets, strategies, roadmaps and budgets.

Smart public finance unlocks effective household and private investment

Governments should seek ways to ensure public spending has the maximum impact possible and stimulates investments from households and the private sector. The cost of hand hygiene can be shared between the government and citizens. Strategic government spending on promotion, reinforcement and education both catalyses and optimizes household investment.

Capacity at all levels drives progress and sustains services

Governments should assess current capacity with respect to their hand hygiene policy and strategies, identify gaps and develop capacity-building strategies based on the rigorous application of best practice. There are serious gaps in capacity for the promotion and sustained uptake of hand hygiene, and for many stakeholders, this represents uncharted territory.

Research into what works in various settings has resulted in critical hand hygiene innovations over the decades. Capacity needs to be built at all levels, across all settings: both nationally and locally, within governments, the private sector and society as a whole.

Reliable data support better decision-making and stronger accountability

Governments should address the need for consistent data on hand hygiene in order to inform decision-making and make investments strategic. Despite efforts to promote hand hygiene, the rates of access to hand hygiene facilities remain stubbornly low.

There are aspects of hand hygiene in health care facilities that are not comprehensively monitored, and little data exists on the availability and affordability of soap. The lack of data makes tracking progress against national and international targets problematic, and, in turn, makes decisions about policy, programming and investment difficult for governments.

Data can be collected through incorporating a standardized handwashing module in household surveys and also through innovative approaches using mobile phones. Examples include crowdsourced data on hand hygiene in public places in Indonesia, and data collected by SMS surveys in Africa on the effects of the COVID-19 pandemic on the availability of soap.

Innovation leads to better approaches and meets emerging challenges

Governments and supporting agencies should encourage innovation, particularly on the part of the private sector, in order to roll out hand hygiene for all, in all settings. New ideas are needed to overcome challenges, such as lack of water supply, uneven soap availability and the impediment of affordability.


Suggested citation: United Nations Children’s Fund and World Health Organization, State of the World’s Hand Hygiene: A global call to action to make hand hygiene a priority in policy and practice, UNICEF, New York, 2021

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