Think Out Of The Box

The hygiene is more important than most people perceive it to be. The Covid pandemic brought the realisation that washing and sanitising hands is significant for the potential to slow down the transmission of respiratory viruses and bacteria –SARS-CoV-2, flu and even common cold. The scientific knowledge as to why soap and water are so effective in slowing down transmission of the virus must be taught and disseminated in schools. We need to create a belief around the behaviour emerging out of the underlying reason, even while we make this a custom or tradition – a habit. The India Sanitation Coalition ran several actions in the hand hygiene space, and explored multiple partnerships to pursue the concerned objectives. Some of these are highlighted later in the article. But before that let me share a rapid assessment of what existed in terms of infrastructure and practice in hand hygiene, until recently, in the country.

Situational Analysis

Hand hygiene is one of the critical steps in preventing the transmission of infectious diseases, including diarrhoea and respiratory illnesses like Covid-19. In many situations, however, both access to hand hygiene facilities and support for essential behaviours are lacking. Though the World Health Organization (WHO) has developed hand hygiene standards for healthcare settings and provides materials that are routinely updated, there is no globally accepted definition or normative advice on this health issue for families, schools or other settings.

In the Indian context too, the reach of such practices is far from expected. According to a recent survey undertaken by the National Sample Survey Organisation, just over one-third of the household members reported washing hands before eating, while less than three-fourths cleaned hands with soap after defecation.

More recently, the Comptroller and Auditor General revealed in a sample survey of over 2,000 schools, which was tabled in Parliament in September 2020, that over half of the government school toilets built by Central public sector enterprises across 15 states lack even the basic handwashing facilities, which is an even greater necessity in these Covid-affected times.

These findings have guided the objectives of Swachh Bharat Mission (SBM)-Rural, Phase I and II. The primary objective was to “bring about an improvement in the general quality of life in rural areas, by promoting cleanliness, hygiene and eliminating open defecation”. As the nation achieved open defecation-free status, the mission was shown to have saved millions of lives and made a lasting impact on health, environment, household incomes and savings, national income and savings, inclusiveness of senior citizens and the differently abled and safety and dignity for women. SBM is widely acknowledged as one of the biggest behaviour change programmes in the world. Amid expressions of praise and acknowledgement of success directed towards the SBM managers and stakeholders, hygiene and the importance of hand hygiene has begun to emerge.

Programmatic Actions

With the Covid pandemic came the realisation that a safely-managed sanitation chain is essential to protecting the health of individuals and communities and environment. The India Sanitation Coalition is deeply engaged in the solid and liquid waste management arrangements in over 600,000 villages of India through Phase II of the rural mission, whose outcome is improved general hygiene. However, hand hygiene and good handwashing habits cannot miss the attention of policymakers and programme managers, as this behaviour change needs continuous reinforcement, as also the provision of infrastructure to enable it.

We knew that the attainment of the targets on hygiene and handwashing was indispensable because of their correlation with other targets such as those for child survival, nutrition, education, equity and gender. However, if we really wish to bring about a change and achieve these targets by 2030, we need to think out of the box and introduce, promote and scale up, innovative products and solutions to promote handwashing with soap and water.

Accordingly, with an intent to make a small, yet impactful, difference in this space, The India Sanitation Coalition has organised a national-level hand hygiene hackathon to identify and reward innovative handwashing infrastructural products which are low-cost, easy-to-maintain and sustainable models and promote/scale-up the most relevant ones through the industry platform of FICCI. Besides, we picked the best infrastructure management systems at the community/institutional levels, through the same competition with a focus on operation and maintenance. All the awardees were given cash prizes and additional support, enabling the piloting of prototypes, and products are reported to be running well in the field.

Handwashing is an essential habit for a healthy and strong India, and the importance being accorded this habit will help us achieve several of committed SDGs.

Naina Lal Kidwai, Chair, India Sanitation Coalition