Innovative handwashing behaviour change programmes key to containing COVID-19 spread

Only 3 out of 5 people worldwide have access to basic handwashing facilities

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Abhishek Sharma Abhishek Sharma

The COVID-19 pandemic has claimed more than 1.5 million deaths globally. It continues to challenge individual hygiene practices and health systems service delivery, especially in the underdeveloped and developing countries. While scientists across the world are striving day and night to develop a vaccine, the world is relying on simpler yet effective prevention measures such as practising handwashing at regular intervals, using face masks, and social distancing to stay safe.

Handwashing is one of the cheapest and the most effective ways to contain the spread of coronavirus and other infectious diseases. However, the fact that only 3 out of 5 people worldwide have access to basic handwashing facilities, renders millions of people ill-prepared in the fight against COVID-19. Not only individuals, but the preparedness of critical public institutions such as schools and health facilities is also no different. According to the latest UNICEF data, more than one-third schools worldwide and half the schools in the least developed countries do not have access to handwashing facilities. Also, 1 out of 6 healthcare facilities has no access to basic hygiene services.

The situation does not seem too promising for India with only 35.8 per cent households practising handwashing with soap or detergent (National Sample Survey 76th round report). The Swachh Bharat Mission took a giant leap in ensuring provisions for handwashing along with the construction of toilets. However, the current COVID-19 crisis calls for a massive behavioural change programme to ensure adherence to handwashing by the masses. A sound behavioural change programme should be based on evidence and must be capable of evolving with emerging trends.

One of the crucial steps in designing a behaviour change communication (BCC) programme is to avoid myths related to behavioural determinants of handwashing. Evidence suggests that BCC programmes focused on increasing awareness/knowledge do not result in sustained behaviour change. Also, research shows that fear of water-borne diseases such as diarrhoea due to poor handwashing behaviour is not a key handwashing motivator. Instead, disgust, affiliation, nurture, comfort, social status, and prestige were stronger motivators for handwashing.

In India, a popular soap brand released a 20-second jingle to remind people of proper handwashing behaviour. Not only was this a musical and entertaining way of reminding people about handwashing but also persuasive with several eminent personalities featuring in the advertisement. The Super Amma (Super Mom) Campaign launched in Andhra Pradesh targeted people’s emotions and it was highly successful. Door to door invitations to mothers and families, use of flipcharts, skits, short films, interactive sessions with mothers, outdoor activities, sticking posters, maintaining report cards of hygiene activities and taking a pledge of using soap and maintaining hygiene led to increasing handwashing practices from 1 per cent to 37 per cent across 14 villages. Another leading consumer goods company launched the ‘High 5 for handwashing campaign’ to raise awareness of the importance of handwashing with soap in reducing child mortality in Bihar and Madhya Pradesh. This intervention used five levers of change by making the programme—understood, easy, desirable, rewarding, and eventually—a habit. It resulted in a substantial drop in cases of diarrhoea.

While convenient access to soap, water, and handwashing facility is a pre-requisite and an important determinant for handwashing, it does not guarantee usage. To ensure the use of handwashing facilities, physical attributes such as colour, shape, size of the soap is also a critical determinant along with the availability of water. To ascertain the behavioural determinants, it is important to study the internal (social norms, beliefs, knowledge) and external influencers (physical factors, infrastructure, visual appeal, access to soap and water) carefully and generate empirical evidence of what works and what does not. A comparative assessment of different intervention approaches will enable implementers to maximize the effectiveness and scale it to several geographies.

The author is a senior manager, Research at Sambodhi Research & Communications, a multidisciplinary research organization offering data driven insights to national and global social development organisations.

The opinions expressed in this article are those of the author’s and do not purport to reflect the opinions or views of THE WEEK.