The COVID pandemic outbreak has brought back into focus the often-neglected practice of handwashing. With several water management programs and health authorities worldwide highlighting the importance of hand hygiene in containing the outbreak, the forgotten fact that hand hygiene has a major role to play in other infections caused by intestinal microbes is now coming back. It is an accepted fact that faecal-oral transmission is one of the key factors in causing a host of diseases. A large population, especially in rural India, suffer from diseases and lose their lives due to lack of toilets/hygienic toilets, lack of awareness of proper hand hygiene, and ignorance about concepts of wastewater management. The underlying problem of containing faecal-oral transmission is of prime importance, especially with the swathes of underprivileged populations in rural India who have little or no access to toilets, soap, and/or clean water.
The Dire Need To Promote The Importance Of Handwashing
Two types of germs exist on the hands:
1) Resident organisms reside beneath the superficial cells.
2) Transient organisms exist on the skin and can be transmitted between people. These are acquired as a result of direct contact with contaminated surfaces and are amenable to removal through practicing hand hygiene.
Hands are the primary pathways of germ transmission throughout daily life. Closed toilets, particularly in rural areas, are a hotbed of pathogens and are the primary source of transmission. Hand hygiene, particularly handwashing with soap, is the most-important intervention with the potential to reduce disease.
It is therefore important to avoid contamination of hands, and this can be achieved through creation of preventive barriers:
1) Primary. Prevention of human contact with faeces through its safe disposal management and its removal from hands after defecation.
2) Secondary. Practice hand hygiene to prevent pathogens existing on the hands before food preparation, eating, or feeding children/elders.
To sum up, wastewater management and water management in India must educate and encourage the rural population to practice hand hygiene—THE most-important tool to prevent disease and provide a safe and healthy outcome for people, especially in rural India. Handwashing as part of hand hygiene is the most cost-effective and sustainable solution in this fight for a disease-free India.
Challenges In Adoption Of Hand Hygiene/ Proper Hand Hygiene
While the importance of handwashing as a primary tool in maintaining hand hygiene is an accepted fact, there are significant issues in its adoption. For instance, it is estimated that close to three billion people have no access to handwashing facilities.
Some of these challenges are discussed below:
- Lack of Education. There is a direct correlation in hand hygiene practiced by families, and education plays a primary role. Statistics show that in families with an uneducated head, only 30% washed their hands with soap and water. On the other hand, those with the family head had at least primary schooling, and the practice was followed by 80% of the households.
- Health Awareness. Many families, especially in rural India, lack awareness on the benefits of regular handwashing, and thus do not follow it. Others simply tend to disregard or forget the same in the absence of cognitive reinforcement.
- Lack of Access to Water And Soap. The lack of availability and water management in India in the rural households forces people (usually women) to venture out to obtain water from common or public water sources. Water is not readily available at dwellings and is often at ration. Handwashing has lower precedence as compared to other needs like bathing, cooking, etc. Similarly, many households have limited or no access to soap due to limited income and either skip or use ash, topsoil, or other means in handwashing, which are not effective.
- Inadequate Knowledge of Appropriate Handwashing. Many are unaware of the proper process of handwashing in that the handwash needs to be a 30– 45-second process, soap to cover all hand surfaces, and proper scrubbing and rinsing.
The Way Forward
Global Handwashing Day, observed on October 15th, is a global advocacy day to increase awareness and understanding of the importance of handwashing with soap. The idea is to propagate handwashing as a cost-effective and effective way to prevent disease and mortality, particularly in the marginalized socioeconomic strata. It helps to raise awareness of and encourage action around handwashing with soap and encourages action at the ground level across society.
The way forward is to adopt a systemic approach, where there is governmental support to support handwashing, which ultimately leads to sustainability, adaptability, and accountability. The government needs to ramp up its communication on the subject through a proper understanding and utilization of networks in the system. A collaborative effort through a public private partnership model and by building networks among the society will enable the effort to succeed at a national level.
Enabling the Vulnerable Rural Population through WASH
WASH is an acronym that refers to “water, sanitation and hygiene.” A regular supply of water, sanitation, and hygiene practices are key components in any basic health service system. The most critical aspects are access to safe drinking water, use of toilets, and hand hygiene.
Correct, consistent, and continuous practices of WASH lead to prevention of disease spread. Rural communities face health challenges due to lack of access to clean water, proper sanitation, and availability of soap and handwashing facilities. To tackle these social, economic, and health-related challenges, S M Sehgal Foundation, in partnership with CAWST (Centre for Affordable Water and Sanitation Technology) Canada, is working with the most vulnerable rural populations on WASH services. The project named “WASH for Healthy Homes” is being undertaken in the Vaishali district of Bihar and aims to spread awareness about the importance of safe drinking water, use of toilets, and the benefits and importance of washing hands thoroughly. Sensitization and awareness-building sessions are aimed at improving WASH behavior. In every session, people are informed that most diseases occur due to not washing hands before cooking meals, before eating meals, and after the use of a toilet.
To tackle the problem of resources, the project team promotes tippy-taps, a zero-cost solution for a handwashing station. These simple, low cost, and locally made systems for washing hands with running water with no hand touch motivate people to practice handwashing in an appropriate manner.
A concluding take on WASH
Health behavior of young schoolchildren are the agents of change as they tend to carry this positive learning throughout their lives. Handwashing facilities made available both in homes and in the schools of children for effective hand hygiene practices prevent diseases and tend to have a multiplier effect on WASH services.
S M Sehgal Foundation, the best rural development NGO in India specializing in water management in India, has been organizing school workshops on safe drinking water in Samastipur, Bihar. The target audience comprised students from class eight onward. The idea was to help generate the word-of-mouth effectively among peers, families, and friends. Soon students and villagers started acknowledging the benefits of safe drinking water, thereby fulfilling the objective of sustainable recall value.