| Reduce the incidence ofdiarrhea and pneumoniain poor communitiesthrough public-private partnerships promotinghandwashing with soap.Support its partners’large-scale, national handwashinginterventions and promote replication of successful approaches.Share scientific evidence showing handwashing with soap to be an exceptionally efficacious and cost-effective health intervention.The inaugural Global Handwashing Daywill revolve around schools and children.Children suffer disproportionately from diarrheal and respiratory diseases and deaths. But research shows thatthe segment of society so often the most energetic, enthusiastic and open to new ideas – can also be part of the solution. Ideally situated at the intersection of the home, school and community, children can be powerfulagents of behavioral change.During Global Handwashing Day – and the surrounding week – playgrounds,classrooms, community centers and the public spaces of towns and cities will be a wash with educational and awarenessraising activity as countries unite to change handwashing behavior on a scale ever seen before.The Public-Private Partnership for Handwashing with Soap (PPPHW) is a coalition of international handwashing stakeholders. Established in 2001, the artnership includes the Water and Sanitation Program, UNICEF, USAID, the World Bank, the Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine,Johns Hopkins University School of Public Health, Colgate-Palmolive,Procter & Gamble, Unilever, the SAID/Hygiene Improvement Project,and the Water Supply and Sanitation Collaborative Council.Handwashing with soap is alife-saving intervention within the technological and financialreach of all countries and communities. But promoting it requires appeals not necessarily to health, but to other things that people value, such as comfort, social status, nurture and a wish to avoid disgust Handwashing with soap works by interrupting the transmission of disease. Hands often act as vectors that carry disease-causing pathogens from person to person, either through direct contact or indirectly via surfaces. When not washed with soap, hands that have been in contact with human or animal feces, bodily fluids like nasal excretions, and contaminated foods or water can transport bacteria, viruses and parasites to unwitting hosts Diarrheal disease: Diarrheal Infections are the second most common cause of death in children under five. A review of more than 30 studies found that handwashing with soap cuts the incidence of diarrhea by nearly half.6 Diarrheal diseases are often described as water-related, but more accurately should be known as excreta-related, as the pathogens come from fecal matter. These pathogens make people ill when they enter the mouth via hands that have been in contact with feces, contaminated drinking water, unwashed raw food, unwashed utensils or smears on clothes. Handwashing with soap breaks the cycle. The figure on the following page shows the effectiveness of handwashing with soap for reducing diarrhea morbidity in comparison to other interventions. Acute respiratory infections: Acute respiratory infections like pneumonia are the leading cause of child deaths. Handwashing reduces the rate of respiratory infections in two ways: by removing respiratory pathogens that are found on hands and surfaces and by removing other pathogens (in particular, enteric viruses) that have been found to cause not only diarrhea, but also respiratory symptoms. Evidence suggests that better hygiene practices – washing hands with soap after defecation and before eating – could cut the infection rate by about 25 percent.7 And a recent study in Pakistan found that handwashing with soap reduced the number of pneumonia-related infections in children under the age of five by more than 50 percent. Intestinal worm and skin and eye infections: Though not as extensive and robust as the research evidence for diarrheal disease and respiratory infections, studies have shown that handwashing with soap reduces the incidence of skin diseases; eye infections like trachoma; and intestinal worms, especially ascariasis and trichuriasis. More evidence is needed but existing research points to the effectiveness of handwashing in reducing the incidence of these diseases. Handwashing is a cornerstone of public health, and new hygienic behaviors and sanitary services were principal drivers of the sharp drop in deaths from infectious disease in affluent countries in the late 19th century. Along with the isolation and safe disposal of feces and the provision of adequate amounts of clean water, handwashing with soap is one of the most effective ways to prevent diarrheal diseases; it is also the cheapest way. In addition, handwashing with soap can limit the transmission of respiratory disease, the largest killer of children under five. Handwashing with soap is also a formidable ally in efforts to combat a host of other illnesses, such as helminths (worms), eye infections like trachoma and skin infections like impetigo. What are the benefits of handwashing with soap? Diarrheal diseases and pneumonia together kill almost 4 million children under the age of five in developing countries each year. Children from the poorest 20 percent of households are more than 10 times as likely to die as children from the richest 20 percent of households. Hands are the principal carriers of disease-causing germs, and handwashing with soap could avert 1 million of those deaths.9 Washing hands with soap after using the toilet or cleaning a child and before handling food can reduce rates of diarrheal disease by nearly one-half and rates of respiratory infection by about one-quarter. Handwashing can also prevent skin infections, eye infections, intestinal worms, SARS and Avian Flu, and benefits the health of people living with HIV/AIDS. Why isn’t it enough to wash with water alone? Washing hands with water alone, a more common practice, is significantly less effective than washing hands with soap. Using soap adds to the time spent washing, breaks down the grease and dirt that carry most germs by facilitating the rubbing and friction that dislodge them and leaves hands smelling pleasant. The clean smell and feeling that soap creates is an incentive for its use. What are the “critical moments” when hands should be washed with soap? Hands should be washed with soap after using the toilet or cleaning a child’s bottom and before handling food. for soap use. Lack of soap can be a barrier to handwashing at schools; however, schools in developing countries often have neither soap nor appropriate handwashing facilities. Building Tippy Taps and getting help from parents’ groups to supply soap or create a small fund for soap are good options. In schools, toilets and handwashing stations are critical to students’ health and to reducing absenteeism. Can handwashing make a difference in overcrowded, highly contaminated slum environments? Yes. A study in Karachi, Pakistan, found that children in communities that received intensive handwashing interventions were half as likely to get diarrhea or pneumonia than children in similar communities that did not receive the intervention. Once people understand the health benefits of handwashing, won’t they automatically do it? No. Human beings the world over fail to do things they should do. If they did, everyone would maintain a healthy weight, no one would smoke or drink to excess and all of us would rise at dawn for an hour of cardiovascular exercise. Is lack of handwashing with soap a problem only in developing countries? Even in places where handwashing is a (comparatively) entrenched practice and both soap and water are plentiful, people often fail to wash their hands with soap. What is the “correct” way to wash hands? Proper handwashing requires soap and only a small amount of water. Running water from a tap is not needed; a small basin of water or “Tippy Tap” is sufficient. (Tippy Taps are cans or plastic bottles that release a small amount of water – just enough for a clean hand wash – each time they are tipped.) One should cover wet hands with soap; scrub all surfaces of hands, including palms, back, between the fingers and especially under the fingernails, for at least 20 seconds; rinse well with running water (rather than rinsing in still water); and dry either on a clean cloth or by waving in the air. An easy way to gauge 20 seconds is to find a familiar song that takes about that long to sing; for instance, it takes about 20 seconds to sing the “Happy Birthday” song twice. Every country has short, popular children’s songs that can be used for this purpose. Is antibacterial soap better at stopping the spread of disease than regular soap? With proper use, all soaps are equally effective at rinsing away the germs that cause diarrheal disease and respiratory infections. What about people who don’t have access to soap? Lack of soap is not a significant barrier to handwashing at home. The vast majority of even poor households have soap in their homes. Research in periurban and rural areas found, for instance, that soap was present in 95 percent of households in Uganda, 97 percent of households in Kenya and 100 percent of households in Peru. The problem is that soap is rarely used for handwashing. Laundry, bathing and washing dishes are seen as the priorities A study in England found that people washed their hands only about half the time after cleaning a child after defecation, and a recent study of doctors’ handwashing practices in the USA revealed that they failed to wash their hands with soap between patient visits with surprising frequency. Medical personnel, who fully understand the health benefits of handwashing with soap, often failed to do so because of lack of time, rough paper towels for drying, inconveniently located sinks and hands chapped by frequent washing with drying soaps. A handwashing campaign begun in 2005 in New York City public hospitals has drastically reduced the number of serious infections, such as blood infections and pneumonia, contracted by hospital patients. How can you change people’s handwashing behaviors? Practitioners in the water supply, sanitation and hygiene sector, as well as manufacturers of soap, have learned a great deal about what works – and what doesn’t – in changing private, personal behaviors and habits. What doesn’t work is top-down, technology-led solutions or campaigns that hinge on health education messages. What is more effective is using approaches that build on the lessons of social marketing. This new approach emphasizes the role of careful formative research (a thorough study of the interests, attributes, needs and motivations of different people within a community). It is also based on the recognition that one size does not fit all and evidence showing that promoting a single message is more effective than promoting multiple messages. The new programs seek to reach and influence their target audiences through multiple mass media and interpersonal communication channels with specific messages designed to respond to their expressed needs and preferences. In short, treating people not as passive project beneficiaries, but rather as active customers motivated by a diverse range of preferences and motivations, yields best results. There is much to be learned from successful interventions in other sectors. Reproductive health programs that pay attention to consumer needs and preferences work better than those that impose top-down targets, evidence shows. Similarly, approaches that create incentives for positive provider attitudes and behaviors get better results than those that rely on targets and punitive management practices. Successful sanitation programs generate community demand for toilets and latrines by appealing to people’s desires for status, acceptance, community solidarity, privacy, convenience, safety and comfort; appeals to health tend to be significantly less effective in motivating behavioral change. The non-health motivations can be compared to the reasons people try to lose weight; maintaining a healthy weight is very important to one’s health – but the reason people go on diets is generally not to be healthier but rather to look better. What is the Public- Private Partnership for Handwashing with Soap? PPPHW is a coalition of international handwashing stakeholders. Established in 2001, the partnership includes the Water and Sanitation Program, UNICEF, the World Bank, the Centers for Disease Control and Prevention, the London School of Hygiene and Tropical Medicine, Johns Hopkins University School of Public Health, Colgate-Palmolive, Procter & Gamble, Unilever, the USAID/Hygiene Improvement Project, and the Water Supply and Sanitation Collaborative Council. Its aims are to: reduce the incidence of diarrhea and pneumonia in poor communities through public-private partnerships promoting handwashing with soap; support its partners’ largescale, national handwashing interventions and promote replication of successful approaches at the global level; and share scientific evidence showing handwashing with soap to be an exceptionally efficacious and costeffective health intervention. The PPPHW harnesses the marketing skills of industry and the capacities of the public sector in a program that aims to save the lives of children. Whose handwashing behaviors are the handwashing promotion programs aiming to change? In many countries, a coalition of public and private organizations have come together to promote handwashing with soap on a large scale. These partnership programs seek to reduce illness and death due to diarrhea and pneumonia among children under the age of five. The primary target groups of PPPHW programs are mothers and other caregivers of children under the age of five. Another target group for handwashing programs is school-age children, who themselves are often caregivers for their younger siblings. School programs can help establish lifelong healthy habits. Who else can take part in promoting handwashing with soap? Everyone can contribute to promoting handwashing with soap! A good first step is to find out what individuals and organizations are already doing and build on that. WASH campaigns –national alliances of governments, parliamentarians, NGOs, media, religious leaders, community groups, schools, private sector actors and other stakeholders – are active in many countries. WASH campaigns aim to advance hygiene and sanitation goals. 2 | ||
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