October 21, 2021

By: Dennis Munai, Rogers Moraro, and Viola Tupeiya – Amref Health Africa in Kenya

Photo credit: NBCC Kenya

With the outbreak of coronavirus disease in 2019 (COVID-19), hand washing has been applied as a mainstay public health measure against the spread of the infection. Moreover, hand hygiene has over ten decades been proven to reduce the majority of community and healthcare-associated infections. Whereas handwashing with soap at the household and healthcare facilities is not a new area, handwashing with soap in public places like markets, transport hubs, places of worship, and commercial shopping malls or centers has gained attention in the wake of COVID-19 pandemic. However, despite the evidenced importance of handwashing with soap, there is a large gap between knowledge and practice of handwashing with soap at critical moments.

In Kenya between the months of April and August 2020, the National Business Compact on Coronavirus distributed 5,311 handwashing facilities to public places in hotspot areas in 46 out of the 47 counties as identified by the Ministry of Health. The interventions included deployment of public handwashing stations, commodities (i.e. soap and water), behavior change communication, technical support to station caretakers and users on operation and maintenance, and monitoring. These handwashing facilities were deployed in three phases with different management arrangements for use by the public as part of the global target of 1 Billion under the UK Aid and Unilever funded Hygiene and Behavior Change Coalition (HBCC) programme.

Photo credit: NBCC Kenya

While public handwashing stations have been central to COVID-19 response, there is little information about public handwashing stations in regards to their functionality, their usability, or their sustained maintenance and operation. In view of these interventions, Amref Health Africa sought to gather experiences, challenges, and lessons that would improve the operation and maintenance of existing public HWS and inform strategies for future roll-out of HWS in public settings in different contexts.

As we commemorate handwashing globally this October, we present the key lessons from the assessment that was conducted between September and December, 2021.

• Key factors that influence the usage include presence of HWS with desirable design features (visible, height and size of water tank), convenient location for easy access and visibility by all and where handwashing is likely to be practiced, availability of water and soap, and creative hygiene materials which keep users’ interest and prompt handwashing at key times.
• Sustainability of the HWS for public places should be given high consideration, contextualized to each setting, and planned jointly with caretakers and/or owners. Operation and maintenance plans should provide clear details about costs and time, be realistic, and most importantly allocate responsibility fairly in a way that would not be burdensome to responsible personnel. Best practices of functionality and sustainability of HWS in public places include encouraging O&M of facilities as an extended role for instance to business people, health facility workers, market attendants, and government office workers.
• More low cost options in regards to source of water, type of soap, options for repairs, and less time-consuming arrangements in regards to refilling of water e.g. pumped automated water supply, should be explored and documented.
• Finally, it is important to identify and understand functionality and O&M measures right from the inception phase with great emphasis placed ensuring that these public HWS are operated and maintained. Where appropriate, consider large water storage tanks linked to the HWS with rainwater harvesting as the source of water. Lastly, these caretakers will need some form of continuous training and capacity building on maintenance and undertaking minor repairs to ensure that the HWS operates optimally.

Photo credit: NBCC Kenya

Overall, the COVID-19 pandemic has brought to the fore the need for handwashing programmes and relevant policies to address the loop on handwashing in public places in a sustainable way. We also strongly recommend inclusion of indicators for global and national monitoring handwashing in public places, which are currently lacking, to enable tracking, programming, and/or reprogramming.

“Our future is at hand – Lets move forward together,” and take stock in the next handwashing day, October 2022!

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