New Delhi: “Wash your hands.” These are perhaps the three most important words we have heard since the COVID-19 breakout. Even in the pre-COVID times, hand washing has been considered a world-changing innovation in public health capable of significantly reducing disease burden globally. Soap is an ancient invention, but the connection between handwashing and health was made less than two centuries ago. Now that its effectiveness is no longer in question, the main focus is on how to make handwashing universal.
According to the World Health Organization (WHO), inadequate availability of water, sanitation, and hygiene results in 8,27,000 deaths in low- and middle-income countries each year. This represents 60 per cent of diarrhoeal deaths globally. Yet the availability of a proper handwashing facility with access to water and soap is a distant dream for many people. The latest global estimates by UNICEF suggest that 3 billion people do not have access to soap and water at home, over 800 million children do not have access to soap and water at school, and 32 per cent of health care facilities are not equipped to practise hand hygiene at points of care.
Evidence from research suggests that handwashing practices differ with location, caste, income categories, education, and gender. Data from the National Sample Survey 76th round report underlines the rural-urban divide with only 25.3 per cent of households washing hands with soap/detergent before a meal and 66.8 per cent after defecation as opposed to 56.0 per cent and 88.3 per cent in urban areas. The National Family Health Survey-4 findings further highlight the disparity in terms of caste, with only 38.4 per cent Scheduled Tribe and 51.9 per cent Scheduled Caste households having the availability of soap and water. The economic status of households is also an important determinant with only 24.3 per cent poorest households having access to soap and water compared to 93.3 per cent richest households. It also suggests higher access in households with better education (84.6 per cent) compared to households with no schooling (42.8 per cent). Another study by WaterAid India, 2017 found that women were more likely to wash their hands compared to men.
Until the COVID-19 outbreak, most of us did not think very often or very deeply about handwashing. Now, with the COVID-19 pandemic claiming more than 108,000 lives in India, good hand hygiene has become one of the most basic yet critical way of curbing transmission of disease. With unlock guidelines being rolled-out, offices and schools set to reopen soon, it is imperative to ensure handwashing facilities and its usage to prevent a spike in COVID cases. The COVID-19 threat presents a veiled opportunity to promote hand hygiene as default and sustainable behaviour. Sustained hand hygiene behaviour will not only prevent deaths due to pandemic but also check diarrhoeal diseases in the post-COVID world.
With the flagship programme- Swachh Bharat Mission (SBM), India has successfully undertaken one of the largest behavioural change programmes in the world. Also, several non-government organizations (NGOs) and Community Social Responsibility (CSR) initiatives have adopted multi-stakeholder and community-based approaches to contribute towards raising awareness, bridging the knowledge-practice gap, building capacity of local health workers, and behaviour change communication to improve hand hygiene practices.
Traditional approaches to behavioural change on hand hygiene have been limited to educational messages via awareness campaigns. However, research shows that education on health risks associated with poor hand hygiene does not necessarily lead to sustained behaviour change.
Multiple factors- emotions, habits, settings, infrastructure, poverty, attitude, and lack of will- prevent the conversion of hygiene-related knowledge into practice and practice into a habit. Programmes on hand hygiene need to appreciate the interplay between these factors and design an integrated approach rather than addressing it in isolation. Door-to-door campaigns, community meetings, emotional messaging, pledge, prayers, could be great platforms to promote the benefits of handwashing.
Despite the recent developments, behaviour change communication on promoting hand hygiene is still an evolving domain. It requires testing of innovative intervention models, robust monitoring and evaluation mechanisms to generate credible evidence, proof-of-concept studies. The silver lining is that many people like me, have now started to develop a new appreciation for handwashing, imagining with satisfaction and relief, a scene of microscopic zapping each time, we wash our hands with soap.
Abhishek Sharma works as a Senior Manager- Research at Sambodhi Research and Communications Private Limited. He has worked extensively on numerous research projects covering a plethora of social and development issues including WASH, livelihoods, poverty, gender, maternal and child health, nutrition, infectious diseases, social awareness, education and renewable sources of energy. Co-author of the book “Is it Really Clean- Creating a WASH Index”, he has introduced an innovative concept of creating a WASH index.
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NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.