A consolidated reply of experiences and examples shared by various members of the Solution Exchange Water Community
From Nitya Jacob, United Nations Children’s Fund (UNICEF), New Delhi
From Shivani Kapoor, Futures Group, New Delhi
Posted 06 October 2009
I work with the Futures Group on the Market Based Partnership for Health (MBPH) project. My experience is in the area of reproductive health and my new project requires me to work on hygiene promotion.
Our secondary research has revealed that there has been some active work on hand washing but there is a lack of representative data on hand washing and its impact on public health. Also, there seem to be a number of institutional alliances in the area of water and sanitation. I would like to understand the successes of these efforts and what the learnings are.
I request the Water Community members to please share with me the following:
1. India-specific data on key scientific evidence of the effectiveness of handwashing and its positive impacts on child health
2. Any studies or research material available on hand washing practices conducted in India
3.Case studies on health effects of hand washing in India and lessons learnt
4. Contact details of persons/organizations actively involved with hand washing related activities (namely research, capacity building, communication material, grassroots level planning and implementation, partnership building, pilot projects and campaigns, etc).
The information provided by members will help to ensure the efforts made through the project are well informed and address the gaps rather than overlap with other ongoing efforts.
Responses were received, with thanks, from
1. Arin Basu, University of Canterbury, New Zealand
2. Anjan Bordoloi, Public Health Engineering Department, Guwahati
3. S. Ramesh Sakthivel, United Nations Children’s Fund (UNICEF), New Delhi
4. J. Geetha, Gramalaya, Tiruchirapalli, Tamil Nadu
5. Pradeep Mohapatra, Udyama, Bhubaneswar
6. Manish Kumar, Krishi Gram Yuva Vikas Samiti, Patna
7. Basanta Kumar Jena, Pragati, Puri, Orissa
8. Afser Ali, Madani Welfare Association, Bhubaneswar
9. B.L. Kaul, Society for Popularization of Science and Progressive Educational Society, Jammu
10. Ajit Kumar Saxena, Energy Environment and Development Society (EEDS), Bhopal
11. Tlaloc, Auroville Water Harvest, Auroville *
Summary of Responses
Comparative Experiences
Related Resources
Responses in Full
Summary of Responses
Washing hands after defecating and before cooking or eating sound like common sense. However, a majority of people do not wash their hands with soap. This leaves them and their children more vulnerable to disease, especially diarrhoea; this is the leading cause of death among children aged 4-14, accounting for 27 per cent of all cases. The other related cause of death, by respiratory disease, is also closely linked to not washing hands with soap.
Studies by different agencies and the Government of India show washing hands at the correct time can prevent 47 per cent of the cases of diarrhoea and prevent a quarter of the resultant diseases. It can also cut the risk of respiratory tract infections by a third. A paper published in Lancet, additional research shows, indicates that washing hands with soap can reduce the risk of diarrhoeal diseases by 42 - 47% and interventions to promote hand-washing might save a million lives. However, people do not wash their hands with soap; in most households, soap is available but used for bathing and washing clothes.
Hand washing is an effective way to block the transmission of pathogens to food and drink. The studies recorded many different occasions for hand washing by child carers, children and adults. These include washing hands after defecation, cleaning the child, handling nappies, before eating and preparing or handling food. The studies found that washing hands after stool contact was relatively rare; after cleaning a child, it was 13 per cent, for the carer after defecation it was 14 per cent. This is significant since children are an important reservoir of diarrhoeal pathogens and the carer is often the person who prepares and serves food.
A technical note by WaterAid says pathogens enter a person’s mouth from unwashed hands directly and indirectly if the person has touched stools. Children are especially vulnerable since they usually play in the same areas where people defecate; they put their hands in their mouths without washing. Pathogens can enter through food and water that has been handled with unwashed hands. Therefore, hand washing at the correct time is critical to prevent pathogens from infecting a person.
Studies on hand washing practices in India show up its poor status, especially before eating and handling water. Most people cursorily rinse their hands with water. Schools are the best place to promote handwashing with soap. The mid-day meal programme that caters to 120 million school children, is an important vehicle for promoting handwashing with soap. This is reiterated by the Department of Drinking Water Supply (DDWS), Ministry of Rural Development that has promoted handwashing with soap as a key hygiene practice. Schools are an ideal place to learn the behaviour of handwashing with soap before eating. These practices, once learnt in school, can be inculcated into household handwashing with soap practices. A study with a sampling of schools showed about 42 per cent of school children are aware of the need to wash hands with soap, but only 12 per cent of schools have soap available. There is thus a gap in demand and supply of hardware.
15th October is the Global Handwashing Day, but it was celebrated in India on 27th October since the 15th was close to Diwali. Millions of children in thousands of schools across the country washed their hands with soap following a carefully demonstrated procedure. They became part of the global movement towards promoting better hygiene practices.
Members noted that in Assam, the Public Health Engineering Department (PHED) and UNICEF worked with a local organisation called the North-East Diocesan Social Forum to promote handwashing among school children in 11 districts. In Tamil Nadu, Gramalaya mounted a campaign with WaterAid and Water.org in three blocks of the Tiruchirapalli district. It covered 30,000 students; each student, in turn, covered five houses to demonstrate how to wash hands with soap and water. Panchayat representatives, teachers and parents realised hand washing helps to reduce diseases.
In Orissa, an NGO Udyama organised a hand washing event for 200 children and 15 parents and teachers. Another NGO Pragati held another event covering 650 students and 30 students. The Madani Welfare Association held a series of events from 23-27 October in the Puri district. They covered 5,000 people, eight schools and 15 villages. Their message focused on the effectiveness of hand washing from the hygiene point of view.
In Jammu, the Society for Popularization of Science and Progressive Educational Society, educated children at a school on the benefits of washing hands with soap after using the toilets and before eating. In Bhopal, Madhya Pradesh the Energy Environment and Development Society along with UNICEF developed a mobile unit approach to create mass awareness on hand washing among children and communities. They also used games to raise awareness about hygiene in rural Madhya Pradesh.
In many other states, the UNICEF state offices and the state government capacity and communication development unit have coordinated hand washing campaigns in their respective states. They have developed IEC material including posters, pamphlets, teachers’ training module and spots for television and radio. Other organisations working to promote hand washing are mentioned in the sections below.
Energy Environment and Development Society (EEDS) launches a Mobile Unit to create awareness about Hand Washing, Bhopal (from Ajit Kumar Saxena, Energy Environment and Development Society (EEDS), Bhopal)
EEDS with the support of UNICEF Bhopal has developed a "Mobile Unit Approach" for creating mass awareness about hand washing among children and communities. A mobile van housing IEC materials is used for creating awareness on hygiene practices. EEDS is studying the experience of using this approach which is being piloted across Madhya Pradesh. This will help to assess the effectiveness of hand washing in improving child health.
School Hand Washing Campaign extends to Families and Panchayati Raj Institutions (PRIs), Tiruchirapalli District (from J. Geetha, Gramalaya, Tiruchirapalli, Tamil Nadu)
Gramalaya as part of its school health programme organized a Hand Washing Campaign in 257 schools. 30,000 school students in 429 villages along with teachers were a part of this campaign. As result students now always carry soap in their bags, having realised the health benefits of hand washing. The students have taken the message home to their families. The PRI members have also come to realise that hand washing has reduced the occurrence of diseases.
A Report on Global Hand Washing Day 2009 (from Afser Ali, Madani Welfare Association, Bhubaneswar)
Report; by Madani Welfare Association; Bhubaneswar; October 2009;
Available at http://www.solutionexchange-un.net.in/environment/cr/res-06100902.doc (DOC; Size: 1.70MB)
Describes how the hand washing campaign in 2009 reached out to 15 villages, 8 schools and around 5000 people in the socially excluded communities of Orissa
Global Hand Wash Campaign 2009 (from Basanta Kumar Jena, Pragati, Puri, Orissa)
Report; by Pragati; Puri; October 2009;
Available at http://www.solutionexchange-un.net.in/environment/cr/res-06100903.doc (DOC; Size: 1.12MB)
Describes in detail the activities undertaken by Pragati as part of the Global Hand Washing Day campaign, whereby the message was conveyed to 653 students in Puri
Celebration of Global Hand Washing Day (from Pradeep Mohapatra, Udyama, Bhubaneswar)
Report; by Udyama; Bhubaneswar; October 2009
Available at http://www.solutionexchange-un.net.in/environment/cr/res-06100901.doc (DOC; Size: 152KB)
Describes the activities undertaken by Udyama on the Global Hand Washing Day when over 200 students were taught the techniques and the need for hand washing
From Arin Basu, University of Canterbury, New Zealand
Effect of Intensive Handwashing Promotion on Childhood Diarrhea in High-Risk Communities in Pakistan
Article; by P. Stephen Luby, Mubina Agboatwalla, John Painter, Arshad Altaf, L. Ward Billhimer, and Robert M. Hoekstra; The Journal of the American Medical Association; USA; 2004;
Available at http://jama.ama-assn.org/cgi/content/abstract/291/21/2547
The article evaluates the effect of promoting household handwashing with soap among children who are at the highest risk of death from diarrhoea
Effect of Several Interventions on the Frequency of Handwashing among Elementary Public School Children
Article; by E. Early, K. Battle, E. Cantwell, J. English, J. Lavin and E. Larson; American Journal of Infection Control; USA;
Available at http://linkinghub.elsevier.com/retrieve/pii/S0196655398800114
It assesses the positive health effects of several interventions such as the frequency of hand washing among elementary public school children
What causes Sustainable Changes in Hygiene Behaviour? A Cross-sectional Study from Kerala, India
Article; by Sandy Cairncross, Kathleen Shordt, Suma Zacharia and Beena Kumari Govindan; Science Direct; The Netherlands; May 2005;
Studies changed hygiene behaviour, including handwashing at various periods up to nine years which shows a link to improved health in Kerala
Talking Dirty: How to Save a Million Lives
Article; by V. Curtis; London School of Hygiene and Tropical Medicine; International Journal of Environmental Health Research; London; 2003;
Available at http://www.hygienecentral.org.uk/pdf/talking%20dirty.pdf (PDF; Size: 96KB)
Discusses how a review of the literature on handwashing puts it on top in the list of possible interventions to prevent diarrhoea, yet few people wash their hands at critical times
Technology Notes (from Nitya Jacob, Resource Person)
Technical Notes; by Caroline Penn; WaterAid; London ;
Available at http://www.wateraid.org/documents/plugin_documents/technology_notes_2008.pdf (PDF; Size: 1.91MB)
Notes that pathogens enter a person’s mouth from unwashed hands if the person has touched stools, thereby reiterating the need for hand washing
Recommended Organizations and Programmes
From Anjan Bordoloi, Public Health Engineering Department, Guwahati
United Nations Children's Education Fund (UNICEF), New Delhi
73 Lodhi Estate, New Delhi 110003; Tel: 91-11-24690401; Fax: 91-11-24627521; newdelhi@unicef.org;http://www.unicef.org/india/children_2357.htm
UN agency working with the government to introduce sanitation and hygiene education into schools and has been actively involved in the Global Hand Washing Campaign
Sarva Shiksha Abhiyan (SSA), New Delhi
Department of School Education and Literacy, Ministry of Human Resource Development, Shastri Bhawan, New Delhi 110001; Tel: 91-11-23383226; Fax: 91-11-23381355; vsarup@sb.nic.in;
http://164.100.51.121/girls-education/kasturba-gandhi-balika-vidyalaya
Government scheme launched in 2004 in backward blocks of the country, one focus area is the establishment of model schools with good hygiene and sanitation facilities
National Rural Health Mission, New Delhi
Ministry of Health and Family Welfare, 401 and 404 A Wing, Nirman Bhawan, Maulana Azad Road, New Delhi 110011; Tel: 91-11-23061647; health@hub.nic.in; http://mohfw.nic.in/
The Mission adopts a synergistic approach by relating health to determinants of good health namely, nutrition, sanitation, hygiene practices and safe drinking water
North East Diocesan Social Forum, Assam
Joypur, Kharghuli, Post Box No. 186, Guwahati 781004, Assam; Tel: 91-361-2521562; info@nedsf.net;http://nedsf.net/health.htm; Contact Father Santiago; Director; Tel: 91-361-2519562; nedsf@rediffmail.com
A Church-based NGO, which has been involved in a hand washing campaign with several schools in Assam aimed to reduce the burden of diseases in school children
From S. Ramesh Sakthivel, United Nations Children’s Fund (UNICEF), New Delhi
Total Sanitation Campaign (TSC), New Delhi
Ministry of Rural Development, Department of Drinking Water, 247, A Wing, Nirman Bhawan, New Delhi 110011; Tel: 91-11-23010207; jstm@water.nic.in; http://ddws.nic.in/tsc_index.htm
The programme aimed at increasing awareness on sanitation among rural people, school students and operationalised India's first handwashing campaign in schools
Department of Drinking Water Supply, New Delhi
Ministry of Rural Development, Government of India, 9th Floor, Paryavarn Bhawan, CGO Complex, Lodhi Road, New Delhi 110003; Tel: 91-11-24361043; Fax: 91-11-24364113; jstm@water.nic.in; http://ddws.gov.in/handwash/
The central government department responsible for providing drinking water and sanitation services and has developed IEC materials to promote hand washing
From J. Geetha, Gramalaya, Tiruchirapalli, Tamil Nadu
WaterAid, New Delhi
Gate No 1, First Floor, Nursery School Building, C-3, Nelson Mandela Marg, Vasant Kunj, New Delhi 110070; Tel: 91-11-46084400; Fax: 91-11-46084411; wai@wateraid.org; http://www.wateraid.org/india/what_we_do/default.asp
Partnered with Gramalaya to organise the Global Hand Washing Day campaign across 257 schools in Tamil Nadu to create awareness about the health effects of hand washing
No 12, 4th Cross West, Thillainagar, Tiruchirapalli 620018, Tamil Nadu; Tel: 91-431-4021563; gramalaya@hotmail.com; http://www.gramalaya.in/aboutus.php
Organised the Global Hand Washing Day campaign which reached 30000 school students in 429 villages, aimed to educate students about the health benefits of hand washing
Energy Environment and Development Society (EEDS), Madhya Pradesh (from Ajit Kumar Saxena)
R-12 GTB Complex New Market, Bhopal 462003, Madhya Pradesh; Tel: 91-755-4768369; eeds@rediffmail.com; Contact Ajit Kumar; aksaxena123@rediffmail.com
A technical support organisation, in partnership with UNICEF developed an educational mobile van for creating awareness among children about the need for hand washing
Arin Basu, University of Canterbury, New Zealand
Here is a link for you to get started. Please visit http://bit.ly/handwash. There are several articles on handwashing in the context of the Indian subcontinent available here. Good luck with your evidence development.
Anjan Bordoloi, Public Health Engineering Department, Guwahati
15th October 2008 was marked as the 'Global Handwashing Day', and was observed throughout India with a focus on hygiene promotion and effectiveness of hand washing among school children specially. Various programmes were organised at grassroots level schools and also case studies were documented.
The agency which took the initiative for this was UNICEF in collaboration with SSA, NRHM, PHED and NGOs/CBOs in many states.
In the state of Assam, the observations of the global handwashing day and its impact was coordinated by an NGO called NEDSF who has covered the maximum number of schools through its NGO network with support from UNICEF. They have also documented case studies, on-spot interviews, evaluations, etc. There email-id is nedsf@refiffmail.com
In 2009 the agencies are planning similar observations on the day with more focus to hygiene promotion in 11 districts of Assam. A positive coordination can provide more relevant data and also other findings.
S. Ramesh Sakthivel, United Nations Children’s Fund (UNICEF), New Delhi
On the 27th October, children in schools across India washed their hands with soap to become part of the global movement towards promoting better hygiene practices during the “Handwashing Day Celebrations” organized by the Government of India with the support of UNICEF. Children learnt and demonstrated the correct way of washing hands with soap with the objective of preventing themselves and their families and peers from diarrhoeal diseases and respiratory infections including the H1N1.
India celebrated the first-ever Global Handwashing Day on the 15th October 2008 through an innovative partnership between the Department of Drinking Water Supply (DDWS) and the Department of School Education and Literacy (DSE&L), Govt. of India, supported by UNICEF, operationalised through the national flagship programmes of Sarva Sikhsa Abhiyan (SSA) and Mid-day Meal (MDM) of DSE&L, and the Total Sanitation Campaign (TSC) of DDWS.
In order to take forward the momentum created in 2008, GoI has decided to associate with the celebration of handwashing day every year and promote sanitation and hygiene with a special focus on handwashing with soap. Since 15th Oct 2009 fell between the Diwali break in most schools across the country, Handwashing Day was celebrated across the states on the 27th October.
Studies conducted on handwashing practices in India have revealed the poor status of handwashing with soap especially before eating food. Schools are the best place to promote the practice of handwashing with soap as the children are willing to adopt these good practices. The midday meal programme which caters to over 120 million children in schools across India can play an important role in promoting the practice of handwashing with soap.
The Department of Drinking Water Supply with the support of UNICEF has developed IEC materials such as posters, pamphlet, teacher’s training module and TV and video spots to promote the practice of handwashing with soap. These can be downloaded at http://ddws.gov.in/handwash/. You may also contact the state CCDUs/UNICEF offices for obtaining these materials in various regional languages.
J. Geetha, Gramalaya, Tiruchirapalli, Tamil Nadu
Gramalaya was conducting a school health programme in 257 schools in Tiruchirapalli District with WaterAid support in 2008. In the project, Gramalaya has organized a mega Hand Washing Campaign in the project areas of Thottiam, Thatheyangarpet and Thuraiyur blocks of Tiruchirapalli District in Tamil Nadu. Special permission obtained from the District Educational officer for conducting the campaign. A detailed action plan was prepared for conducting the hand washing campaign with Gramalaya staff, TSC and District educational office. It has been planned to utilize 30000 school students in 429 villages with teachers and PLF leaders’. 60000 Handwashing stickers were printed about hand washing techniques. It was planned that each student has to cover 5 houses and demonstrate how to wash hands with soap and water. Gramalaya Health educators explained in detail about this in the previous day in 300 schools and demonstrated the technique. On hearing this news the secretary of the Scout Association of Tiruchirapalli District has voluntarily contacted Gramalaya and told that the teachers and Scout students would also participate in the campaign.
The inaugural function was organized in the respective blocks with Panchayat leaders of the area. The campaign was inaugurated in a different manner. School teachers, educational department officials, school students, PRI members, PLF leaders had participated, and the students demonstrated, as to how to wash hands before the audience. Then the students went to the house and called the inmates of the house, and explained the purpose of the visit and told them the importance of hand washing and hand washing in the critical times etc. and pasted the stickers in the doors. Then they asked them to bring some water in a bucket or tub and demonstrated them how to wash hands with soap and water. The adults and kids in the house eagerly watched the demonstration and promised the students that they will follow it from the next day onwards. The students took 10 to 15 minutes in each house to complete their exercise.T he teachers, PLF leaders, SHG members and staff were going along with the students and clear the doubts when questions arise by the community. Hindustan Lever dealers, petty shop owners, PRI members donated sample soaps worth about Rs. 15000 for this purpose. There was a heavy demand on that day for sample soaps and not even a single soap was available in any shops. 286 schools, 18451 school students, 324 school teachers, 69 panchayat presidents, 2 union chairman, 58 Gramalaya staff, 180 PLF leaders and TSC officials have covered 60013 households in one day. During this campaign, most of them got the knowledge on hand washing techniques.
Impact of the Handwashing campaign
- The community wonders about Hand washing techniques in critical time. Students always having a small bit of soap in their bags. Illiterate people also asking questions on seeing the stickers on the doors.
- Teachers realized that school health should be included in syllabus like other subjects.
- PRI members realized that hand washing is reducing diseases.
- This camp forms a way to involve all sector peoples like District Educational office, SSA, PRIs, HLL, Elected representatives, Scout Association and NSS students.
- Children are instructed their parents to wash hands before cooking and serving the food.
- Demonstration by students in their houses appreciated by their parents and realized about the importance of hand washing.
Pradeep Mohapatra, Udyama, Bhubaneswar
UDYAMA participated in this global hand washing celebration on 15 October. You can see the report at http://www.solutionexchange-un.net.in/environment/cr/res-06100901.doc. This underscores the importance of hand washing.
Manish Kumar, Krishi Gram Yuva Vikas Samiti, Patna
Hand washing for Child Health is a very challenging job. We will also work towards this but there are many problems to be addressed first. I have personally seen that the Day was not celebrated in at least 20 schools in Delhi and this needs to be addressed. We can work through our network of organisations because we believe children are the right target group.
Basanta Kumar Jena, Pragati, Puri, Orissa
We participated in the Global Handwash campaign-2009. As a result of this:
- 653 nos. of students were aware of hand wash and its advantages.
- 30 teachers and helpers were aware of hand wash and its advantages.
- The SWSC members, women slum dwellers, Anganwadi teachers and students participated in the programme and understood the technique of hand wash.
- The message of hand wash in critical time communicated to 11 slums through public meeting and street play.
- The street plays gave the message of safe drinking water, use of toilet and hand wash advantages.
For more details please read the report at http://www.solutionexchange-un.net.in/environment/cr/res-06100903.doc (DOC; Size: 1.12MB)
Afser Ali, Madani Welfare Association, Bhubaneswar
Our organization organised the Global Hand Washing Day on 23-27 October 2009 in Pipili block, Puri district, Orissa with the support of WaterAid U.K. Please find the report on the same attached at http://www.solutionexchange-un.net.in/environment/cr/res-06100902.doc (DOC; Size: 1.70MB). During this process we reached 5000 persons through door-to-door campaigns.
B.L. Kaul, Society for Popularization of Science and Progressive Educational Society, Jammu
We at Ankur Vidyalaya Public High School Jawahar Nagar, New Plots, Jammu, a school for disadvantaged children, celebrated Global Handwash Day on 15 October 2009 and educated children about the benefits of washing hands with soap and water at least five or six times a day i.e. after visiting wash room and before and after eating meals. The school provided soap for washing hands before children ate their lunch in the school. In this manner we are trying to raise awareness about the effectiveness of handwashing on child health.
Ajit Kumar Saxena, Energy Environment and Development Society (EEDS), Bhopal
Thank you for raising this important query. Energy Environment and Development Society (EEDS) with the support of UNICEF Bhopal has conceived and developed a "Mobile Unit Approach" for creating mass awareness among children and communities. The Mobile Van housing different IEC materials, Educational Tools and Games for creating awareness on sanitation and hygiene practices is being used in many villages of Madhya Pradesh.
Out of these two games are popular in the villages: “JOKER KE SATH DHOEAN APNE HATTH ( Wash your hand with Joker)" and "Kick to Kitanu (Kick the Germs)". The Cabinet Minister of Bhopal participated in one of the programme and played the games along with the other Panchayati Raj members and officials.
We are studying the experience of using the Mobile Unit Approach (A basket of tools to offer an integrated package for trigger and team building and which is being piloted/used in many villages of Madhya Pradesh. For more information on the approach and the tools used, you may kindly contact us at eeds@rediffmail.com.
Tlaloc, Auroville Water Harvest, Auroville*
Raising awareness about handwashing is great. However, having travelled all over India and seeing toilets everywhere, I have observed that 90% of the time there is no soap when you come out of the toilet to wash your hands? Educational programmes will be of no good if the soap is missing.
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