Handwashing has become a basic need for survival during the COVID-19 pandemic. However, for many across the world, accessing soap and water at home to carry out a simple 20-seconds handwashing ritual a few times a day is still a luxury. According to the UNICEF and WHO Joint Monitoring Programme report 2019, published earlier this year, 40 percent of the world’s population, or 3 billion people, do not have a handwashing facility with water and soap at home.
On 'Global Handwashing Day', talking about the crucial need to incorporate handwashing practices, Dr. Yasmin Ali Haque, UNICEF India representative said, “As the pandemic continues to spread, it is important to remember that hand washing is no longer just an individual choice, it is a societal imperative. It is one of the lowest costs and highly effective measures you can take to protect yourself and others against coronavirus and many other infections.” “As schools consider the new parameters for reopening, we need to make sure that they continue to prioritize access to handwashing with soap, clean drinking water, and safe sanitation for every child,” she added.
In India, in fact, access to handwashing facilities is a major cause of concern. The Joint Monitoring Programme (2019) estimated that only 60 percent of India's households have handwashing facilities with soap. In rural areas, the availability of these facilities is even lower. Worldwide, only 3 out of 5 individuals have basic handwashing facilities.
The report further states that "43 percent of schools lacked a handwashing facility with water and soap, affecting 818 million school-age children. In the least developed countries, 7 out of 10 schools have no place for children to wash their hands with water and soap." You can read more about the report here.
Previously, The National Sample Survey (NSS) report of 2019 had also shown that only 25.3 percent of rural Indian households and 56 percent in urban areas wash hands with soap or detergent before a meal. However, 2.7 percent of households still use ash, mud, or sand to clean their hands before meals.
Therefore, as the pandemic continues to claim lives and infect lakhs, it is imperative to take steps to make handwashing facilities available to the poor and the marginalized. However, the pre-existing water scarcity makes it a challenging task.
"One of the crucial issues that Indians face in cities is formal access to water, which has been further aggravated by the pandemic. For instance, in cities, the homeless population, of course, has no formal access to water, so for them taking the most basic precaution from COVID-19, that's handwashing, is tough to do. Even for those in slums, the water supply is either informal or intermediary. The cost of water has gone up exponentially during the COVID-19 times when we are repeatedly telling people that they need to focus on hygiene rituals like handwashing. The slum dwellers are generally daily wage workers, street vendors, or sanitation workers who are already struggling to keep their jobs; how can they bear such water costs? And under such circumstances, how can they use water for handwashing, when they need to save it for cooking and drinking?" asked Sitaram Shelar of the Pani Haq Samiti.
With COVID-19 and the handwashing needs, we need to re-estimate the amount of water required per person in each household. "Access to water is the basic dignity that everyone should have, but slum dwellers who often live in informal settlements are already so vilified for living there. Making formal water accessible to them for drinking, and cooking, let alone handwashing, isn't something authorities are focusing on," added Shelar.
Apart from the obvious water scarcity problem, handwashing practices are also hard to incorporate in most rural and urban households due to the lack of designated spaces for handwashing, pointed out Arundati Murlidharan, Manager Policy at WaterAid India. "When we talk about handwashing practices, we also have to think about proper infrastructure to facilitate the process. That's not necessarily a sink and a tap, there has to be a designated space -- within a household or school or Anganwadi, or a health center -- where people can go to wash hands, that is well equipped with water and soap," said Murlidharan.
"However, if you look at rural or urban low-income households, that designated spaces are not available in most cases. Through our research, we have found that there are some rural households that have such spaces, but they do not have both water and soap, which undermines the practice of handwashing. In some cases, in fact, such spaces are located in inconvenient sections of the property, perhaps not near the kitchen, or the toilets, which again doesn't facilitate the habit of handwashing. Therefore, we have been advocating for the need to create such spaces ever since the pandemic started," she added.
Murlidharan also pointed out that while the privileged automatically assumes that soap is easily available, for many low-income families, soaps are luxuries that are rationed. Therefore, handwashing, especially if it is not related to toilet use or before eating, is not important to them. "However, as COVID-19 has revealed, there are other critical times too, when we need to wash our hands. Therefore, there is also the need to make the soap more easily and widely accessible to all, and in sufficient quantities, so that everyone can wash hands," explained Murlidharan.
Another thing that is crucial now is better awareness campaigns, which are targetted and effective enough to bring about behavioral changes. "There had been a huge amount of efforts in advocacy during COVID-19, not just from the government level but also from NGOs and civil societies," said Murlidharan.
"However, there is still a gap that these messaging doesn't fill. Many people still don't understand why do we have to wash our hands? How does washing hands protect you from COVID-19? How does soap work in killing germs? Our own research suggests that people may not be making these links very strongly." said Murlidharan.
Also, there is a need to move beyond the generic campaigns that focus on washing your hands and sending out more tailored messages depending upon the age group, section of society, and geographical locations of the target audience. Nowadays, very few people are following protective measures, because the fear of COVID-19 has gone into oblivion. It has become normal for us to live in Covid times. Therefore, to incorporate handwashing as a permanent behavior may become more difficult in time. Under such circumstances, simple nudges help. Hand washing also requires reminders like everything else in life, but the reminders don't have to be a ten-step guide on washing hands next to a sink; they need to be more innovative. For instance, in the Delhi metro, footprints have been drawn from toilets to the handwashing stations to give people visual cues to wash hands.
Several Governments, too, are trying to encourage handwashing practices among its citizens. For instance, in collaboration with UNICEF, the government of Jharkhand is outlining school reopening strategies, which focus on water, sanitation, and hygienic handwashing facilities in schools. UNICEF had also developed an online training module and pushed it through the existing Swachh Vidyalaya Swastha Bachhe (SVSB) application, under which they have trained 150,000 teachers in hygiene and handwashing practices, before the school re-opening process.