Review of hand washing programmes

The conclusion states that many interventions for handwashing with soap at critical times have demonstrated measurable, often substantial impact. They have been shown to be cost-effective with new handwashing practices sustained beyond the end of the intervention. Most of these successful programmes were of short to moderate duration (one to two years) which has also enhanced their cost-effectiveness. Programmes for handwashing have reduced the risk of diarrhoeal disease and also of upper respiratory infections. The time is ripe for interventions on a large and medium scale that promote handwashing.

Most programmes have combined different types of actions and different channels to reach target audiences. There is some evidence from the six country study (Shordt et al, 2004) that the intensity of the intervention and horizontal, interpersonal or small group communication, are associated with the sustainability of handwashing and hygiene behaviours.

However, in general, there is a lack of consistent monitoring and evaluation processes, something which limits our ability to develop evidence-based lessons learned. Among the approaches, PPP, participatory (particularly PHAST) and social marketing strategies need further assessment. Success at scale needs to be more fully studied.

Many of the successful programmes were mounted through collaboration with health departments, local government and civil society. Inter-agency cooperation appears to be a key to effective programming. Even though handwashing may not, at first glance, be politically attractive, the PPP programmes have shown that political leaders are willing to support this issue.

Overall, even though many questions remain… even though there are gaps in documentation and assessment processes… it has been demonstrated that effective programmes can be mounted for handwashing with soap. The question is not whether handwashing programmes, or health interventions with a handwashing component should be undertaken. The challenge is to move forward at pace, with cost-effective and focused interventions of medium and large-scale. The lessons learned from the past demonstrate that it will be possible to address this challenge successfully.