Scrub up: why investing in hand hygiene saves lives and catalyzes economies

Today, three in 10 – or 2.3 billion people, representing 29% of the world’s population – don’t have access to handwashing facilities with water and soap available at home, even in some high-income settings. Two in five schools worldwide do not have basic hygiene services with water and soap, affecting 818 million students, and one in three healthcare facilities globally lack hand hygiene at points where patients receive care.

Following the onset of COVID-19, hand hygiene received unprecedented attention, emphasizing handwashing with soap and water as a critical component against the spread of the virus: It lowers the risk of transmission by 36%. Governments around the world demonstrated their leadership in promoting a culture of hand hygiene by establishing new requirements for hand hygiene in institutional settings, especially in healthcare where infection prevention and control is so critical for safe care. Individually, millions more people globally value and practice hand hygiene for its life-saving impact.

It’s clear that expanding access to hand hygiene should not only be seen as a temporary public health measure in times of crisis, but as a long-term priority that can address the burden of disease and support pandemic preparedness well into the future. But this will require significant commitment, investment and collaboration from leaders from the public and private sector. Recent work to understand the cost of achieving full coverage of water, sanitation and hygiene (WASH) and waste services in public health facilities in the least developed countries, estimates that between $6.5 billion and $9.6 billion would be required between now and 2030. (Hygiene accounts for 10.7% of this figure, or $845 million.) Understanding the resourcing needs for hygiene provides an evidence base for governments to work with the public and private sector to establish the financing and resourcing that is critical to enable a national culture of hand hygiene, both in and outside of healthcare settings.

This heightened awareness of need and increased demand also present an opportunity to improve the availability of high quality yet affordable hand hygiene goods and services, so that handwashing occurs in more places and at all critical moments for healthier, more resilient communities. This market opportunity calls for a shift in both the type of products and services offered, and in the management of hand hygiene services – in households, schools, public spaces and healthcare settings.

As a result of this sharpened focus on hand hygiene, governments in over 60 countries, supported by the WHO/UNICEF Hand Hygiene for All Initiative, have initiated efforts to create national hand hygiene policies that increase access in critical sites. This is to be achieved through prioritization of financing, regulation around hygiene requirements in institutions and public settings, as well as enabling public policies and actions to address structural trade barriers.

In Africa alone, at least 839 million people across both urban and rural areas have limited access to hand hygiene. Achieving the 2030 SDG targets in the African Union will require a 42-fold increase in basic hygiene services. In August 2021, a WHO and UNICEF study estimated that the economic cost of universal hand hygiene for all in household settings in 46 of the least-developed countries of the world is $11 billion over 10 years. Forty-nine per cent of this price tag covers handwashing facilities, supplies and soap, representing a market opportunity of $5.39 billion.

The onset of the COVID-19 pandemic further placed a spotlight on the existing need for improved hygiene in the home and public places and spurred innovation by public health authorities, civil society organizations and the private sector. UNICEF and LIXIL’s shared value partnership to promote sanitation and hygiene, Make a Splash!, recognized this gap and collaborated to address it. SATO, a brand of LIXIL that caters to low-income communities with innovative sanitation and hygiene solutions, started working on a new handwashing station based on newly prioritized plans to develop a hand hygiene product.

UNICEF’s insights of sector expertise and emerging trends and needs for hand hygiene products in over 100 countries where they operate, combined with SATO’s market intelligence and other partner inputs, resulted in prototypes that prioritized water savings, simplicity and affordability. The resulting design, SATO Tap, a unique handwashing device that can be attached to most locally available plastic bottles and allows handwashing with as little as 100ml is now ready for markets throughout Africa and Asia.

Together, the government, private sector, civil society and partners can pioneer new ways to tackle global hand hygiene challenges. Not only can these partnerships demonstrate how leaders can foster national cultures of hand hygiene, but they can future-proof countries against new pandemics with smart investments in this area. Research has found that a national handwashing behaviour change programme would provide a 35-fold return on investment in China, and a 92-fold return in India.

UNICEF and the World Economic Forum have launched the Hand Hygiene Market Accelerator, which aims to reach 1 billion people by 2030 by catalyzing investments and expertise from public and private partners to shape local markets to produce and deliver suitable, high quality, yet affordable hand hygiene products and services in a systemic, sustainable and resilient way.