New data cast light on poor hygiene

This week is World Water Week. Each year, leaders and experts meet in Stockholm to discuss global challenges relating to water. This year the conference celebrates its 25th year, with a specific focus is on water for development. There will also be lots of discussion about the broad spectrum of water issues ranging from water resources and climate change to access to the most basic of drinking water and sanitation facilities. There will be some, but all too little debate about the related topic of hygiene.

Four surprising facts on hygiene

  1. Handwashing with soap is one of the most effective interventions to reduce diarrhoea and pneumonia, two leading causes of child mortality.
  2. Research studies have suggested that very few people – approximately one in five globally – wash their hands after going to the loo. Whilst these data are limited they certainly demonstrate the scale of the challenge.
  3. Last year the Guinness World record for handwashing was won when almost 13 million students washed their hands simultaneously across over 1,300 schools in Madhya Pradesh, India.
  4. Menstrual hygiene remains a taboo in many settings – with poor knowledge and misconceptions as great a challenge as access to adequate facilities at home as well as at school. Learn more about menstrual hygiene and its impacts on women and girls in the Menstrual Hygiene Matters report.

It also happens to be the 25th anniversary of the WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation, whose report at the end of the Millennium Development Goals showed that 663 million people still lack an improved source of drinking water and 2.4 billion lack an improved sanitation facility.The ability to track progress on drinking water and sanitation during the last twenty-five years has helped to draw attention to people without basic services and to highlight persistent inequalities both between and within countries. Until recently, far less attention had been given to hygiene, which unlike water and sanitation, was not part of the Millennium Development Goals and has not been systematically tracked at the global level.

An adolescent girl takes part in an handwashing demonstration for a group of adolescent girls in Chowrapara, Rangpur, on 28 April 2014.  Chowrapara, Rangpur, January 2014: 13-year old Arjina wants to become a doctor one day. A few months ago, that dream nearly shattered. Arjina’s parents – her mother a housewife, her father a daily wage laborer – were constantly struggling to make ends meet. They were also continually worried if they did enough to protect their daughter from harassment from boys and men. Then one day, a marriage proposal was given to Arjina’s father. In Rangpur district in northwestern Bangladesh where Arjina and her family lived, parents commonly arranged the marriage of their daughters during adolescence, and nearly half of all girls were married by the age of 15. In light of this tradition of early marriage for girls, and considering their dire financial situation and their concerns for their daughter’s safety, Arjina’s parents decided to accept the marriage proposal. Arjina told her mother that she did not agree to get married so young. But it had no effect. Arjina then sought help from the Community Worker, Giribala Roy, who she knew from community dialogue sessions on child marriage. Giribala Roy from the local NGO Assistance for Social Organization and Development (ASOD), supported by the UNICEF Communication for Development program, works to change harmful behaviours and social norms in the community, such as child marriage. Giribala alerted the local Ward Development Committee and government authorities at sub-district level, and together they visited Arjina’s parents. They argued that adolescent girls were physically and mentally not ready yet for marriage and childbirth. They also talked about the penalties for parents who marry their children before the legal age of 18. The local skilled birth attendant discussed the increased health risks when adolescents get pregnant. Experiencing community pressure and listening to the
© UNICEF/BANA2014-01296/PaulAn adolescent girl takes part in an handwashing demonstration for a group of adolescent girls in Chowrapara, Rangpur, on 28 April 2014.

Of the range of hygiene behaviours considered important for health, handwashing with soap is a top priority in all settings. Handwashing with soap is one of the most effective interventions to reduce diarrhoea and pneumonia, two leading causes of child mortality. But handwashing behaviours are tricky to measure – people know the “right” answer and are very likely to tell you it if you ask them directly. For that reason, the most practical approach leading to reliable measurement of handwashing is observation of the place where hands are washed and noting the presence of water and soap at that location. This lets you know whether households have the necessary tools for handwashing and provides a proxy for their behaviour. Learn more by reading the World Bank’s Water and Sanitation Program working paper: Practical Guidance for Measuring Handwashing Behavior.

The data for over 50 countries show consistently low levels of access to handwashing facilities in many countries, particularly in sub-Saharan Africa but also Southern Asia and Latin America and the Caribbean. For example, in the Democratic Republic of Congo fewer than one in ten people have access to a facility. In countries with higher coverage overall, such as Mongolia – the poorest are greatly disadvantaged: only one in ten have access compared with almost all of those in the wealthiest quintile (96%). Similarly, people living in rural areas are less likely to have access to handwashing facilities – as is the case in Afghanistan where they are only half as likely as people in urban areas. Explore the available handwashing data for yourself using the interactive dashboard on handwashing.

The great news is that hygiene is part of the new Sustainable Development Goals and is specifically mentioned together with sanitation in Target 6.2 which by 2030 seeks to ‘achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations’. UN member states still need to select an indicator for handwashing to track progress and ensure these ambitions are properly reflected.And you can join the Global Public-Private Partnership for handwashing campaign to advocate for a handwashing SDG indicator. Over the next few years, data will then continue to be collected in household surveys such as the Multiple Indicator Cluster Surveys and Demographic and Health Surveys and it will become possible to tell whether and how much the situation has improved. The data will also tell us whether the international community is giving hygiene the attention it most surely deserves.

Robert Bain is a Statistical Specialist focusing on water, sanitation and hygiene in UNICEF’s Data and Analytics Section in New York.

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