The Importance of Handwashing for Public Health
Handwashing with soap is a simple yet powerful behavior that can significantly reduce the spread of infectious diseases and improve overall public health outcomes. Studies have shown that handwashing with soap can decrease the risk of diarrheal diseases by up to 47% and respiratory infections by 23% (Freeman et al., 2014). This makes handwashing one of the most cost-effective public health interventions, with the potential to save hundreds of thousands of lives each year.
Despite the clear benefits, handwashing rates remain alarmingly low in many parts of the world. Global estimates suggest that only 19% of people wash their hands with soap after contact with excreta (Freeman et al., 2014). This low uptake is particularly problematic in low-income communities, where poor sanitation and hygiene contribute to the transmission of deadly diseases like cholera, dysentery, and typhoid.
To address this critical public health issue, development organizations and governments have increasingly focused on community-based approaches to promote sustained handwashing behavior change. These approaches recognize that handwashing is not just an individual behavior, but one that is shaped by social norms, environmental factors, and community dynamics. By engaging communities as active partners in the change process, programs can foster long-lasting improvements in handwashing practices.
Designing Effective Community-Based Handwashing Programs
Successful community-based handwashing programs share several key design elements:
1. Understand Local Contexts and Barriers
Effective programs begin by conducting formative research to deeply understand the local context, including cultural beliefs, social dynamics, and practical barriers to handwashing. This helps ensure that interventions are tailored to the specific needs and realities of the target community.
For example, a study in rural Pakistan found that key barriers to handwashing included a lack of knowledge about the health benefits, competing household priorities, and the perception that water is a scarce and precious resource (Plutzer et al., 2017). Incorporating these insights into the program design helped address the root causes of poor handwashing practices.
2. Engage the Whole Community
Community-based approaches recognize that handwashing behavior is influenced by social norms and community-level factors. Effective programs therefore engage a diverse range of stakeholders, including community leaders, teachers, health workers, and caregivers. This helps build collective ownership and support for handwashing promotion efforts.
In Burkina Faso, a successful handwashing program used a multi-pronged approach, including interpersonal communication, school-based activities, and community events (Curtis et al., 2001). By involving a wide array of community members, the program was able to shift social norms and establish handwashing as a expected community practice.
3. Empower Communities as Change Agents
Rather than top-down education campaigns, community-based approaches position communities as the drivers of change. Programs help communities identify their own handwashing challenges, develop locally-relevant solutions, and take the lead in implementing and sustaining behavior change efforts.
One example is the Community-Led Total Sanitation (CLTS) approach, which has been effectively adapted to promote handwashing in several countries. CLTS empowers communities to analyze their own sanitation and hygiene practices, and then take collective action to improve them (Kar & Chambers, 2008). This sense of community ownership and agency is key to ensuring long-term behavior change.
4. Utilize Multiple Communication Channels
Effective programs leverage a diverse mix of communication channels to reach different segments of the community. This can include interpersonal outreach, mass media campaigns, community events, and digital platforms. By using a multi-modal approach, programs can reinforce handwashing messages and make them more salient and actionable for target audiences.
In Vietnam, a large-scale handwashing program combined national TV and radio spots with community mobilization activities, such as handwashing demonstrations and school-based programs (Chase & Do, 2012). This integrated approach helped increase handwashing rates by 41 percentage points.
5. Address Infrastructural and Enabling Factors
While behavior change is central, community-based programs also address the enabling environment for handwashing. This includes ensuring access to affordable handwashing supplies, such as soap and water, as well as creating handwashing-friendly infrastructure in homes, schools, and public spaces.
For example, a study in rural Mali found that a Community-Led Total Sanitation (CLTS) program not only triggered collective action to build latrines, but also led to the construction of handwashing stations near toilets (Pickering et al., 2015). This integration of hardware and software components was crucial for sustaining improved handwashing practices.
Measuring Impact and Ensuring Sustainability
Evaluating the impact of community-based handwashing programs is critical for understanding what works and why. While measuring behavior change can be challenging, programs should use a mix of observation, self-reported data, and indirect indicators (such as soap sales) to track progress.
It is also important to consider long-term sustainability. Effective programs build local capacity, foster community ownership, and integrate handwashing into existing systems and structures. This helps ensure that behavior changes outlast the initial program implementation period.
For instance, the Global Handwashing Partnership has developed a “Sustainability Framework” to guide programs in addressing key pillars of sustainability, including institutionalization, financing, and social mobilization (Global Handwashing Partnership, 2016). By taking a holistic approach to sustainability, programs can catalyze lasting improvements in handwashing practices.
Conclusion: The Power of Community-Led Change
Handwashing with soap is a simple yet powerful behavior that can save lives and improve public health. However, achieving widespread and sustainable handwashing behavior change requires a deep understanding of local contexts and a commitment to empowering communities as the drivers of change.
Community-based approaches that engage diverse stakeholders, leverage multiple communication channels, and address both behavioral and infrastructural factors have proven effective in increasing handwashing rates and sustaining improved practices. By harnessing the power of community-led change, we can unlock the tremendous potential of handwashing to transform health outcomes around the world.
To learn more about the Joint Action for Water initiative and its commitment to community-driven water and sanitation solutions, please visit https://jointactionforwater.org/.
References
Biran, A., Schmidt, W. P., Varadharajan, K. S., Vijayakumar, L., Rajaraman, D., Kumar, R., … & Curtis, V. (2014). Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial. The Lancet Global Health, 2(3), e145-e154.
Chase, C., & Do, Q. T. (2012). Handwashing behavior change at scale: Evidence from a randomized evaluation in Vietnam. The World Bank.
Curtis, V., Cairncross, S., & Yonli, R. (2000). Domestic hygiene and diarrhoea–pinpointing the problem. Tropical Medicine & International Health, 5(1), 22-32.
Freeman, M. C., Stocks, M. E., Cumming, O., Jeandron, A., Higgins, J. P., Wolf, J., … & Curtis, V. (2014). Hygiene and health: systematic review of handwashing practices worldwide and update of health effects. Tropical Medicine & International Health, 19(8), 906-916.
Global Handwashing Partnership. (2016). Handwashing Sustainability Framework. Retrieved from https://globalhandwashing.org/resources/handwashing-sustainability-framework/
Kar, K., & Chambers, R. (2008). Handbook on Community-Led Total Sanitation. Plan UK and Institute of Development Studies, University of Sussex.
Pickering, A. J., Null, C., Winch, P. J., Mangwadu, G., Arnold, B. F., Prendergast, A. J., … & Levine, D. I. (2019). The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea. The Lancet Global Health, 7(8), e1139-e1146.
Plutzer, K., Batool, Z., Nabeela, K., Azam, A., Jung, J., Azizullah, A., … & Hameed, M. A. (2018). Low incidence of hand washing, footwear use and defecation in latrines in Pakistani rural communities: The value of evaluating local context for WASH implementation. PloS one, 13(3), e0193045.
