October 25, 2018

Calls to Action for Integrated Advocacy for Global Handwashing Day

Written by Ebuwa Evbuoma, Global Handwashing Partnership

Group of students standing around a tap

© 2014 Asad Rassel, Courtesy of Photoshare

The intersection of handwashing with soap and household meal time is the cornerstone of this year’s Global Handwashing Day.  Handwashing with soap is an integral component of food hygiene, a system of hygienic practices that keep food safe and prevent food-related illnesses, including diarrheal diseases. Food hygiene also comprises several other important aspects, such as: keeping utensils and dishes clean, properly storing and reheating food, boiling water and milk where needed, and thoroughly cooking food.[1]

Globally, handwashing with soap is one of the most important public health interventions, impacting health, nutrition, education, equity, and the economic development of countries. To scale up the wins in handwashing coverage, there is a need for integrated, harmonized advocacy for hand hygiene with related issue areas, such as nutrition.

As many as 70% of cases of diarrhea may be associated with poor food hygiene.[2]  Contamination of food can lead to a wide range of illnesses and outbreaks, many of which have pregnant women, fetuses, and people with compromised immune systems as particularly high-risk groups.1 The negative effects of undernutrition during the first 1,000 days of life on physical growth, immune system and brain development may be irreversible.[3] Hygiene promotion activities have shown improved food hygiene behaviors and reduced microbial contamination in food.[4]

Presently, the national averages of access to soap and water in households range from below 10% to nearly 100%. [5] Such resource gaps can only be narrowed by focused, action-oriented partnerships between governments, partners and stakeholders to improve hand hygiene.

The Global Handwashing Partnership leverages partnerships and networks to advocate for handwashing with soap as an integral component of international development. With the presence of hygiene as a target in the Sustainable Development Goals (SDG 6, Target 6.2), there is an increasing global awareness of the challenges and opportunities for improved hand hygiene.

The challenges and opportunities of this intersection were explored during the 2018 Handwashing Behavior Change Think Tank. A session explored existing research and implementation on the integration of hygiene and nutrition.  One major message of the session was that the relationship between hygiene and nutrition is complex, but neither element will succeed in changing health outcomes without the other.

This discourse was facilitated by the review of a recent multi-arm cluster randomized control trial in Bangladesh[6] measuring the benefits of water, sanitation and hygiene (WASH) interventions to improve child health and development outcomes. The trial revealed no additional impact on linear growth compared to nutrition alone with any of the WASH interventions, but showed a significant improvement in child development, particularly cognitive development. This strongly presents a case for advocacy for the prevention of the long-term impacts of recurrent diarrheal illness, while it challenges hygiene behavioral change messaging stereotypes and highlights the need for further multi-arm hygiene and nutrition integration trials.

Global Handwashing Day presents an advocacy opportunity for community members, advocates, government-level representatives and private sector entities to increase prioritization of handwashing and food hygiene. Well-executed, advocacy is a powerful tool to empower decision makers to implement desired actions – research, policy, and infrastructural investments – in hand hygiene implementation. This is achieved by:

  • Seeking out or creating networks of community or local government-level representatives invested in the multiple benefits of handwashing on food hygiene, nutrition and health. This can begin with district level executives, or Departments of Health and Sanitation. A case study of interest can be found in India’s multi-stakeholder Sanitation and Hygiene Advocacy and Communication Strategy Framework.
  • Sharing research and data on food hygiene and handwashing programming activities with the public, the media, and policy makers. Policymakers and executives come from diverse backgrounds, hence, a focused , evidence-based presentation of the state of hand hygiene in the focus communities is instrumental to decision-making.
  • Reaching out to stakeholders working in health, education, nutrition, water, sanitation, and hygiene; and other sectors. Handwashing promotion is not limited to the WASH sector. In the Philippines, for example, the Department of Education, with partner implementers, rolled out nation-wide group handwashing and other hygiene activities in elementary schools across the country.
  • Convening policy makers to advocate for increased investment in hygiene, to develop a declaration, or with specific policy requests. This requires planning and a clear understanding of policy and parliamentary mechanisms, which vary from country to country. Our Clean Hands for All toolkit can help guide your advocacy.
  • Advocating for the adoption of multi-stakeholder monitoring frameworks on the status of handwashing facilities in regional areas.[7] A notable monitoring framework is the World Health Organization (WHO)/United Nations Children Emergency Fund (UNICEF) Joint Monitoring Programme (JMP) for Water Supply, Sanitation and Hygiene. This framework provides disaggregated data, sourced from index countries, to benchmark progress towards the SDGs.

The good news is that there are boundless opportunities for integrated advocacy for hand hygiene with other sectors. A good example is the Clean, Fed and Nurtured coalition, a coalition of over 75 organizations spanning civil society, academia and multinational NGOs, who work in water, sanitation and hygiene; nutrition; maternal, newborn and child health; and early childhood development. This network provides a resource of best practices for integrated program implementation and advocacy.

Everyday should be a hand hygiene day. Handwashing with soap should be emphasized during critical moments, especially before a meal or after using the toilet. The benefits of this simple act go far beyond disease prevention. Never has there been a better time for a call for integrated advocacy to ensure that all communities everywhere can meet hand hygiene targets.


[1] Biran, A., Curtis, V., Gautam, O., & Greenland, K. (2012). Background Paper on Measuring WASH and Food Hygiene Practices–Definition of Goals to be Tackled Post 2015 by the Joint Monitoring Programme. London School of Hygiene & Tropical Medicine, (May 2012), 81

[2] Adams M.R & Motarjemi Y. (1999). Introduction. In WHO Food Safety Programme, Basic food safety for health workers (pp. 7). Geneva: World Health Organization. (WHO/SDE/PHE/FOS/99.1)

[3] Grantham-McGregor, S., Cheung, Y. B., Cueto, S., Glewwe, P., Richter, L., & Strupp, B. (2007, January 6). Developmental potential in the first 5 years for children in developing countries. The Lancet. https://doi.org/10.1016/S0140-6736(07)60032-4;

[4] Gautam, O. P., Schmidt, W. P., Cairncross, S., Cavill, S., & Curtis, V. (2017). Trial of a novel intervention to improve multiple food hygiene behaviors in Nepal. American Journal of Tropical Medicine and Hygiene, 96(6), 1415–1426. https://doi.org/10.4269/ajtmh.16-0526

[5] Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and SDG Baselines. WHO, UNICEF, 2017. https://www.unicef.org/publications/files/Progress_on_Drinking_Water_Sanitation_and_Hygiene_2017.pdf

[6] Luby,S.P; Rahman, M., Arnold, B.F; Unicomb, L. & Ashraf S. et al. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial. Lancet Glob Health 2018; 6: e302–15. http://dx.doi.org/10.1016/ S2214-109X(17)30490-4

[7] Ram, P. (2013). Global Scaling Up Handwashing: Practical Guidance for Measuring Handwashing Behaviour 2013 Update. Water and Sanitation Program (World Bank) Working Paper. Available at: https://www.wsp.org/sites/wsp.org/files/publications/WSP-Practical-Guidance-Measuring-Handwashing-Behavior-2013-Update.pdf