Lack of investment in handwashing leads to additional healthcare costs, lost or decreased productivity, and loss of life. For example, research has found that a national handwashing behavior change program would provide a 35-fold return on investment in China, and a 92-fold return in India.[i]

Cost effective chart

Handwashing is one of the most cost-effective investments in public health. Disability-adjusted life years (DALY) helps measure the effectiveness of health interventions by combining information about years of life lost and years lived with a disability. Handwashing with soap has been shown to be the most cost- effective way to avert DALYs associated with diarrheal diseases. The cost of averting one DALY through hygiene promotion including handwashing is US$3.35.[ii]

WHO’s Commission on Macroeconomics and Health considered an intervention to be ‘very cost effective’ when it can avert one DALY for less than the per capita GDP. Handwashing with soap meets this criterion, even in the countries with the lowest per capita GDP.

Handwashing is particularly cost effective when compared to other interventions.

An investment of US$3.35 in handwashing promotion is estimated to deliver the same amount of health benefits as a US$11 investment in latrine construction, a US$200 investment in household water supply, or an investment of many thousands of US dollars in immunizations.[iii]

Handwashing is substantially less expensive than other public health interventions. A 2013 study indicated that in some developing countries, annual net costs of diarrhea and pneumonia incur more than $12 billion per year, while estimated costs of a national handwashing program would be less than $100 million and bring $2 to $5 billion in savings.

The 2017 study referenced above estimated that a national handwashing program in India could yield returns of US$5.64 billion, or a 92-fold return on investment. A similar program for China could yield a net annual return of US$2.64 billion, a 35-fold return on investment. The authors noted that national handwashing behavior change programs could significantly reduce infections in both countries, and offer excellent value for money.[iv]

The economic benefit from handwashing is not isolated to the prevention of diarrhea and pneumonia, as infections from other sources also pose an economic cost to countries, even in high-income countries. Healthcare-associated infections (HCAI), the majority of which can be prevented by good hand hygiene, are extremely costly to individuals, healthcare systems, and countries. The economic loss attributed to the direct costs associated with HCAIs in Europe is €7 billion per year. In the United States, the annual cost was estimated in 2004 to be US$6.5 billion.[v] Hand hygiene interventions have been shown to be effective in reducing drug-resistant infections in hospitals. In fact, one model estimated that each increase of 1% in hand hygiene compliance could save nearly $40,000 in MRSA-related healthcare costs per year.[vi]


[i] Townsend J, Greenland K, Curtis V. Costs of diarrhoea and acute respiratory infection attributable to not handwashing: the cases of India and China. Trop Med Int Health, 2017; 22(1): 74-81.

[ii] Walker DG, Hutubessy R, Beutels P. WHO guide for standardisation of economic evaluations of immunizations programmes. Vaccine, 2010; 28(11): 2356-59.

[iii] Cairncross S, Valdmanis V. Water Supply, Sanitation, and Hygiene Promotion. In: Jamison DT, Breman JG, Measham AR, et al., [editors]. Disease Control Priorities in Developing Countries. 2nd edition. Washington DC: The International Bank for Reconstruction and Development / World Bank; 2006. Chapter 41. Available from: Co-published by Oxford University Press, New York.

[iv] Townsend J, Greenland K, Curtis V. Costs of diarrhoea and acute respiratory infection attributable to not handwashing: the cases of India and China. Trop Med Int Health, 2017; 22(1): 74-81.

[v] World Health Organization (n.d.). Health care-associated infections: Fact sheet.

[vi] World Health Organization (n.d.). Evidence of hand hygiene to reduce transmission and infections by multi-drug resistant organisms in health-care settings.