Covid-19 in low-income countries – we need rapid learning about effective handwashing initiatives

08 April 2020

Frequent and proper handwashing with soap is one of the most important measures that can be used to prevent the spread of the Covid-19 virus, along with physical distancing, avoiding touching one’s face (eyes, nose and mouth) and practising good respiratory hygiene. However, like physical distancing measures, frequent handwashing with soap and water is next to impossible for huge swathes of the global population.

Global figures on handwashing facilities are stark – 40 percent of households and 50 percent of schools do not have a facility with soap or water and 40 percent of healthcare facilities do not have access to soap and water or hand sanitizer at points of care. The UK Government recently pledged £50 million of UK Aid to fund a global programme to tackle the spread of coronavirus with an additional £50 million coming from Unilever. Money will be spent to raise awareness about handwashing and also provide over 20 million hygiene products. This should be welcomed but how it is used effectively to change behaviours in the short-term and over the long-term is a question which has to remain open.

Changing handwashing behaviours is notoriously difficult

Approaches to tackle handwashing usually include a focus on ‘hardware’ (handwashing stations, soap etc.) and ‘software’ (handwashing promotion and behaviour change communication often done through face-to-face engagement and community meetings). Changing handwashing behaviours is notoriously difficult unless people see an imminent threat and believe their actions will help mitigate it.  A systematic review published in 2017 reviewed evidence from 42 impact evaluations and 28 qualitative studies across low and middle-income countries concluded that community-approaches were most effective but even these approaches struggle with sustaining handwashing behaviours.

We still do not know how communities in different parts of the world are going to react to the threat of Covid-19. We do know that messaging needs to take care it does no harm – that handwashing is not viewed as the sole solution but as one of different behaviours needed to slow the spread. We also know that handwashing promotion and behaviour change activities, including tackling the spread of misconceptions, will only work if communities are fully engaged.

Community engagement is key

Experts who worked on Ebola response and on the HIV/AIDs pandemic have also stressed the importance of community-engagement – empowering people to be able to take actions to protect themselves. Therefore rapid community engagement is vital to tackle handwashing and the pandemic more widely.

How we go about physically distanced community-engagement and hygiene promotion is a question we do not have a definitive answer for. Yes, there are people with smart phones and social media accounts but they cannot be relied upon to spread messages to the most vulnerable who may not have access to these.

Logistical challenges of community engagement

In the UK, for example, news reports have highlighted the challenges of interacting with elderly relatives using newer forms of communication, like WhatsApp or FaceTime, that many of us take for granted. We need to think through the different ways to engage communities remotely and maintain their central role in interventions as well as answer the logistical challenges of providing services to those who need them most. Both of these will require rapid action learning and sharing: learning and research methods that produce timely findings that are in-touch and up-to-date and which can be acted on. Platforms such as the Social Science in Humanitarian Action can be utilised for sharing these lessons.

In this highly dynamic and uncertain global situation, we need to be both innovative and coordinated in how we respond, as practitioners attempt to increase handwashing facilitates and influence behaviours. We need to be innovative in ways we can learn and share lessons from across different governments and agencies and adapt to this ever-evolving crisis.

What is working and what is not?

We need to be identifying what is working, as well as what is not, and disseminating lessons learnt rapidly to others. Building on each other’s successes and avoiding making the same mistakes twice. This includes government-led activities and citizen-led actions where governments have failed to act in a timely way.

In Nicaragua, a civil society coalition, Unidad Nacional, together with a scientific committee are creating a movement to get correct information to families and communities – inspiring citizen-led solutions in the streets, shops and markets. This includes setting up handwashing stations and developing communication materials.

If we can achieve this in this time of crisis, we need to ensure that we maintain momentum on handwashing as normality resumes and with a strong learning agenda in order to achieve safely managed sanitation and hygiene for all by 2030!

The Sanitation Learning Hub is committed to supporting Rapid Action Learning on handwashing during the Covid-19 crisis and for the WASH sector more broadly. If you would like more information, please see our programme page or email [email protected]