By Dr Yasmin Ali Haque
Almost two decades ago, a researcher from the London School of Hygiene and Tropical Medicine had called the simple act of washing hands with soap a do-it-yourself vaccine! Valerie Curtis, a prominent global hygiene advocate, who passed away this year, was referring to the immense potential of hand washing to significantly reduce diarrheal deaths, the second biggest killer of children. Since then, hand washing with soap at essential times is recognized as an important behaviour to prevent infections and save lives, especially for vulnerable children and families.
Her words have acquired a new urgency in the last nine months, during which COVID-19 has claimed over a million lives globally, while the search for a vaccine to combat the virus is yet to yield concrete results. This means, hand washing with soap, that cuts the risk of viral transmission by 23-40 per cent according to global studies, along with social-distancing and masks, will remain one of the first lines of defense against COVID-19 in the foreseeable future.
There is an increasing momentum for this on several fronts.
A 2020 rapid assessment by WaterAid in India found that 67 per cent of respondents surveyed are seeking out information about when and how to wash hands with soap.
PM Modi’s Jan Andolan or people’s movement on COVID-19-appropriate behaviour launched on October 8, 2020 clearly emphasises the importance of practising the three preventive behaviours: wearing masks properly; washing hands frequently; maintaining safe distance of six feet.
There is also a global push by UNICEF and WHO through a Call to Action for all countries to create their own national hygiene road maps through the recently launched ‘Handwashing for All’ campaign.
Some of these were reflected in the celebrations around Global Handwashing Day this year by many political leaders, religious communities and celebrities throwing their weight behind hand hygiene campaigns and interventions.
How do we translate this momentum into behaviour change? How do we encourage everyone to make hand washing a regular practice? How do we sustain it beyond this pandemic?
For this to happen, we need to see the following three in motion:
First, every person must fully understand and appreciate the importance of washing hands with soap — essential for mitigating the spread of COVID-19, but also common diarrheal diseases like influenza, cholera and pneumonia.
The National Sample Survey 76th Round from 2019 revealed that 35.8 per cent of household members reported washing hands with soap before eating, while 74.1 per cent did so after defecation. The country loses 320 children under five years every day due to diarrheal diseases, most of which are preventable and, can be attributed to compromised access to safe hygiene, as well as sanitation and water supply.
We will need to sustain and build on these gains, we need to spark a people’s movement around hand washing, bringing together everyone including young people, parents, PRIs, religious leaders, policymakers, and the private sector for a cultural shift for hand washing to be integrated into everyday practices.
Children can be important influencers and innovators in this endeavour. Take for instance, Riya — a teenager from Madhya Pradesh who realised her home lacked a hand washing station. With money being tight, she decided to make one of her own! Riya installed a tippy-tap foot operated hand washing system — a two-bottle system, one of which contains soapy water, another plain water. After Riya made a video of her innovation, it unleashed a micro-revolution of sorts, and in no time, 7,000 villages had erected their own such stations. Such innovations add impetus in ushering the needed positive change.
Second, people must have access to soap, water and hand washing facilities.
Hand hygiene is simple yet powerfully-effective in prevention of infections. We know, however, that it is poorly practised in most parts of the world, including in India. Part of it is due to the lack of access to water, soap and hand washing facilities, especially in places like schools, healthcare facilities, and public spaces, including marketplaces and transport hubs. Almost 40 per cent of people globally either do not have access to, or are unable to afford water and soap at home.
In India, as per NFHS-4, only 18 per cent of rural households and 30 per cent of rural India have access to piped water supply. Institutions like schools and hospitals often lack necessary infrastructure to allow for adequate hand washing. Lack of functional toilets is one of the reasons girls drop out of school when managing menstruation becomes a challenge.
The Government of India’s 100-day Jal Jeevan Mission (JJM) campaign launched October 2, 2020 to provide potable piped water to all schools, health centers, Anganwadi centers and other public institutions across the country, is a welcome step in this direction. Reaching the last mile and the most vulnerable families and children with safe water remains critical.
Post the COVID-19 lockdowns, the return to full normalcy of essential services such as immunization, primary health care and re-opening of schools are contingent on following the essential COVID-19 preventive behaviours. Provision of hand washing facilities is indispensable to this effort. Only when these are adequately in place can the trust be restored, and fears allayed allowing children, parents to access these essential services.
Finally, innovative solutions are needed to address hand washing in resource-poor settings.
We will need to be cognizant to the specific and special challenges of different communities and geographical locations. This includes designing appropriate eco-friendly and low-flow hand washing station models for areas which face water scarcity. Hand washing can and should be made aspirational, fully leveraging the ongoing emphasis on hygiene and cleanliness in the Swachh Bharat Mission Phase Two and the JJM, on achieving universal access to safe drinking water.
COVID-19 has driven home the importance of hand washing with soap. Even after we are able to access the vaccine, it will remain crucial to mitigate the adverse impact of any future outbreaks.
It also presents to us with a once-in-a lifetime opportunity to ensure universal access to hand hygiene and to make it a part of our daily lives.
It’s up to each one of us to act and adopt this simple behaviour and to save lives today and in the future!
(The writer is a representative at UNICEF India)
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