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Table of Contents


Volume 34, Issue 4, 2021


Volume 34, Issue 4, 2021


Dr. Santosh Jatrana, Alfred Deakin Institute


October 15 is Global Handwashing Day, a date designated to raise awareness and understanding about the importance of handwashing with soap to reduce the risk of disease.  

Figure 1: Global Handwashing Day.

Hands are one of the most important routes through which infection is transmitted. This is because hands acquire the pathogens from contaminated surfaces and transfer them to other entry points for pathogens such as mouth, nose or eyes. In 2017, it was estimated that 707,000 people died prematurely due to lack of handwashing facilities (Ritchie & Roser, 2021). Post the emergence of COVID-19 there is a renewed emphasis on good hygiene practices, specifically handwashing, for protecting against coronavirus disease (COVID-19) infection and breaking the chain of transmission. Never before, have handwashing practices ever received so much global attention, as in the current time. 

Handwashing with soap and water at key times is heralded as one of the most cost-effective measures to reduce the global burden of gastrointestinal and respiratory diseases and more effective than the use of ash, soil, sand or other materials that are employed in some cultures for handwashing. Research has shown that programmes to improve handwashing and buying soap are less expensive than the cost of treating diseases that result from inadequate hand hygiene, and in a survey of women and girls, access to hygiene service was among the main ways identified for improving health care. (Global Handwashing Day 2021). The ability to handwash, stay healthy and miss fewer days of school is also thought to help improve wellbeing, dignity, educational fulfilment and productivity, which can help to reduce inequality in a society. 

In 2020, however, only 20.6% of the world’s population had limited access to handwashing facilities with no soap, and 8.6% had no access to handwashing facilities at all. This issue is predominantly true of low- and middle-income countries, particularly lower-income countries of Sub-Saharan Africa and Asia, where water may also be so dirty that it is difficult to maintain good hygiene. In 2020, 40.3% of the population of Sub-Saharan Africa had limited access to handwashing facilities with no soap, whilst 33.75% had no access to handwashing facilities at all. As a consequence, it was estimated that in Sub-Saharan Africa, in 2017, death rates due to no access to handwashing facilities were 33.01 per 100,000. 

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Initiatives to improve hand hygiene

In 2015, Sustainable Development Goal 6 (SDGs) ‘Clean water and sanitation’ included a specific target (6.2) of achieving adequate and equitable access to hygiene by 2030.  

Figure 2: Sustainable development Goal 6.

A significant amount of financial and human resources have been invested in various campaigns and initiatives to improve the awareness and practice of appropriate handwashing. These initiatives include the Global Handwashing Day, the Water and Sanitation for Health Facility Improvement tool (WASH FIT) published by WHO and UNICEF, the Global Handwashing Partnership to promote handwashing with soap, and the UNICEF Hand Hygiene for all initatives.

Many initiatives primarily aim at behaviour change for which family plays an important role. Adolescents’ handwashing practices, in particular, have been found to be suboptimal by the Global School-based Student Health Survey (GSHS) conducted in 87 countries. This survey, developed by the World Health Organization and the United States Centre for Disease Control and Prevention, (CDC) in collaboration with a number of organisations, found that adolescents’ handwashing practices were suboptimal, irrespective of socioeconomic disparities, in most of the countries surveyed but particularly in the Western Pacific and African regions. Instilling appropriate handwashing practices in young people, therefore, will help reduce transmission of disease as well as establish good practices in adult life. While many factors are associated with instilling good handwashing practices among adolescents, family level factors such as adolescent’s parental supervision, parental bonding and parental connectedness have been found to play an important role

Without exception, in all the regions, the prevalence of “always” handwashing before eating, after using the toilet and using soap was higher among those who reported having parental supervision, parental bonding and parental connectedness. It is possible that parents spending more time with their children may have more chances to talk with them about their health-related concerns and/or beliefs. The design and development of hand hygiene promotion policies and programs, therefore, should ensure parental involvement in hand hygiene activities.

The results from this study have global implications, especially in the current climate of COVID-19 as recent waves of COVID-19 with the delta variant have shown increased rates of infection amongst children (0-19 years) and young adults (20-39 years). While school-based intervention strategies—including school closures and hygiene and health intervention programs have been shown to be cost-effective in reducing the spread of infectious diseases, family-based behavioural interventions are needed to persuade children to develop independent and healthy hygiene behaviours, which can endure throughout adulthood. 

Education programs alone, however, may have limited success in changing hand hygiene practices where access to handwashing facilities are limited or non- existent, or provision of soap and water forms a significant part of a household’s expenditure. In 2020, 2.28 billion people did not have access to basic handwashing facilities at home with 670 million people having no handwashing facilities at all (Global Handwashing Partnership). Approximately 50% of schools also lacked handwashing points for students and 32% of healthcare facilities lacked handwashing points for patients (UNICEF, n.d). 

Solutions to the hand hygiene issue in the least developed countries need to be affordable and appropriate for low-income families. One such solution is the Tippy Tap that does not require access to running water, is affordable, uses materials that are readily available and has a simple mechanism. Water is held in a standard plastic drink bottle attached to a stand that can be tipped, using a lever operated by the foot. 

Figure 3: Tippy Tap.

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Progress in achieving hand hygiene targets

In 2015, 67.3% of the world’s population had access to basic handwashing facilities (with soap and water), and this figure had increased to 70.7% in 2020. This is a relative percentage change of 5.5%; however, there is considerable variation between countries and regions. In Sub-Saharan Africa, a region where access to basic handwashing facilities in 2020 was only 25.9% of the population (810 million people), the relative percentage increase was only 4%, with some countries, such as Sudan, have shown a decrease in the percentage of the population with access to basic handwashing facilities (Ritchie & Roser, 2021).

Such rates of change in accessing basic handwashing facilities are insufficient to meet the target set by the Sustainable Development Goals for 2030. If the current rate of progress continues, it is estimated that 1 in 5 people will still lack access to basic handwashing facilities in 2030 (Ritchie & Roser, 2021). This has severe consequences for the health and wellbeing of people living in low- and middle-income countries. Still, it also has consequences for the worldwide recovery from the Covid-19 pandemic and protection against future pandemics.

Student Activities

  1. Outline the impacts of no access to handwashing facilities in the short term and long term.
  2. Access the website and describe the spatial pattern of death rates from no access to handwashing facilities in 2017.  Also, describe how the spatial pattern of death rates from no access to handwashing facilities has changed since 1990.
  3. Access the website Then compare the % of the population with access to basic handwashing facilities in urban and rural areas in different regions of the world. Identify three countries in Asia that have experienced a substantial increase in access to basic handwashing facilities in rural areas since 2010.
  4. Suggest reasons why it may be difficult for some countries to improve access to basic handwashing facilities.
  5. To what extent are family factors important in establishing good handwashing practices?


Christie, D.; Viner, R. Adolescent development. BMJ 2005, 330, doi:10.1136/bmj.330.7486.301

Curtis, V.; Cairncross, S. Effect of washing hands with soap on diarrhoea risk in the community: A systematic review. Lancet Infect. Dis. 2003, 3, 275–281, doi:10.1016/S1473-3099(03)00606-6.

Global Handwashing Day 2021. (2021). Global Handwashing Day 2021 Factsheet. Retrieved August 27, 2021 from

Global Handwashing Partnership. (n.d.). Global Handwashing Day. Retrieved August 27, 2021 from

Jatrana, S.; Hasan, M.M., Mamun, A.A., Fatima, Y. (2021). Global Variation in Hand Hygiene Practices Among Adolescents: The Role of Family and School-Level Factors. International Journal of Environmental Research and Public Health. 18, 4984. ijerph18094984.

Ritchie, H., & Roser, M. (2021). Clean Water and Sanitation. Retrieved August 28, 2021 from Our World in Data:

Song, I.H.; Kim, S.-A.; Park, W.-S. Family Factors Associated With Children’s Handwashing Hygiene Behavior. J. Child Health Care 2013, 17, 164–173.

Tran, D.; Phongsavan, P.; Bauman, A.; Havea, D.; Galea, G. Hygiene behaviour of adolescents in the Pacific: Associations with socio-demographic, health behaviour and school environment. Asia Pacific J. Public Health 2006, 18, 3–11.

UNICEF. (n.d.). Handwashing. Retrieved August 27, 2021 from

UNICEF Handwashing with Soap, Critical in the Fight against Coronavirus, is “Out of Reach” for Billions. Available online: (accessed on 5 August 2021).

UNICEF Handwashing Stations and Supplies for the COVID-19 Response. Available online: (accessed on 5 August 2021).

UNICEF WASH Understanding Hygiene promotion in the context of Risk Communication & Community Engagement (RCCE) and Infection Control and Prevention (IPC) for the COVID-19 Outbreak. Available online: (accessed on 5 August 2021).

WHO. (n.d.). Retrieved August 27, 2021 from

WHO Global School-Based Student Health Survey (GSHS): Purpose and Methodology. Available online: (accessed on 10 September 2020).

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