November 16, 2015
The Global Public-Private Partnership for Handwashing has been very involved in promoting a hygiene indicator in the Sustainable Development Goals (SDGs). An indicator for handwashing would ensure that this important behavior is prioritized and measured at the global level. In this blog, Libbet C. Loughnan, co-author of a new article in WaterLines, explores how handwashing has been measured as a way to guide future measurement.
Libbet C. Loughnan consults for the Water Practice of the World Bank, as an Advisor on the Water, Sanitation, and Hygiene Indicators, Washington, D.C.
If a question “please show me where members of your household most often washes their hands” leaves you at a loss, then chances are your household doesn’t wash their hands. Furthermore, if you think they do but you show the place to an observer, and there is no water and soap to be seen, then it is difficult for you to really be washing your hands. This logic gives an easy way to understand the importance of monitoring the “% of the population with handwashing facilities with soap and water at home”.
Pneumonia and diarrhoea are the leading causes of child mortality worldwide (Liu et al., 2012). Hand hygiene interventions can reduce gastrointestinal illnesses such as diarrhoea by up to 42 per cent and acute respiratory infections (ARI) by up to 34 per cent (Aiello et al., 2008). Handwashing with soap has also been shown to be associated with reduced neonatal mortality (Rhee et al., 2008) and skin infections (Luby et al., 2005). Handwashing with soap may be one of the most cost-effective interventions to improve public health.
Furthermore, if you are a woman in the menstruating phase of life (and approximately half are), and your household doesn’t have a place for handwashing, then you face additional challenges to your personal hygiene and the accompanying dignity.
We link here to an article published this month in Waterlines. It reviews the history of nationally representative handwashing measurements up to 2008, in two of the main survey networks that contribute to monitoring of the Millennium Development Goals (MDGs): the Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS). This more random use of a range of handwashing measurements across 48 surveys led to official adoption in 2008 of one that had been used in 17 surveys since Kazakhstan in 1999: that collected data on the “% of the population with handwashing facilities with soap and water at home”.
The two networks included this in their core survey design since 2009 and it has now been collected by over 65 surveys worldwide. As well as in our article, the newer phase of data can be seen on page 44-45 of the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP) 2015 report. Thus measurability is firm, and data already available.
The data gives key insights into patterns of health and dignity outcomes, suggesting low handwashing rates in many low- and middle-income countries with high prevalences of water and sanitation-related diseases, particularly among the poorest rural residents. The data can be used to inform handwashing interventions for targeted areas where the necessary components of handwashing are missing and related diseases are common.
The JMP officially monitored water, sanitation and hygiene (WASH) access on behalf of the international community under the MDGs. The indicator “% of the population with handwashing facilities with soap and water at home” came out as a main priority when the JMP coordinated a process for consensus on what should be monitored in that domain in the next phase of global development goals: the Sustainable Development Goals (SDGs). This was the largest consultation on global WASH goals during the period 2011-2014, and offered as an input to the Inter Agency and Expert Group on SDG Indicators (IAEG-SDG).
This all sounds very technical. But please stay with me.
The SDGs and Targets are already set. Target 4.a. is “Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all”. And Target 6.2 is “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations”.
But how is success or failure verified?
Along with the hygiene indicator, the consensus-building process of 2011-2014 pointed towards an accompanying indicator to capture the “sanitation” (and open defecation) component of the Target of 6.2 (“% of population using safely managed sanitation services”). And a proposed indicator for 4.a. relied on the hygiene indicator: “Percentage of schools with access to (i) electricity; (ii) Internet for pedagogical purposes (iii) basic drinking water and (iv) basic sanitation facilities; and (v) basic handwashing facilities (as per the WASH indicator definitions)”.
The “sanitation” indicator is already given the metaphorical “green” light but also literal “green” classification in the IAEG-SDG work. It will officially verify whether or not we achieve success in sanitation. And the 4.a. indicator is officially given the green light.
Thus the monitoring of hygiene in both Target 4.a. and Target 6.2. relies on the accompanying existence of the 6.2 hygiene indicator.
But officially this 6.2 hygiene indicator is not [yet] given a green classification in the IAEG-SDG process. The JMP has developed a plan for implementing global assessments on the hygiene indicator in case it’s given the green light. And the data exists, in our article and in new fieldwork worldwide. So there is an option for having global monitoring of this health behavior that is essential to achieving child mortality reduction goals, and definitional to Target 4.a. and Target 6.2. The IAEG-SDG process extends until February 2016, so by then we will see whether the opportunity gets the official go-ahead.
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