December 18, 2020

On Thursday, December 17, 2020, the Global Handwashing Partnership hosted a webinar entitled “Addressing Handwashing at a Systems Level” as part of its Handwashing Thursday Series. The series aims to amplify the launch of the Partnership’s most recent publication: The Handwashing Handbook. The handbook, which launched on Global Handwashing Day 2020, serves as an all-in-one resource for handwashing and hand hygiene programming.

The webinar focused on the last chapter of the handbook: Addressing Handwashing a Systems Level. The presentations sought to clarify the systems approach for handwashing, providing examples from Vietnam and Nigeria. The webinar also featured a presentation focused on the recently launched Hand Hygiene for All Global Initiative.

Introduction to a Systems Approach

The webinar started with an overview presentation from Mr. Ron Clemmer of the Global Handwashing Partnership. In his presentation, he went over the definitions for a system and systems approach. A system can be defined as an interconnected set of actors that jointly produce a society outcome. Likewise, a systems approach ensures there is a strong system to support handwashing, which ultimately leads to great sustainability, adaptability, and accountability. He presents the Sanitation and Water for All building blocks for a system, outlined below:

These building blocks can be useful in understanding the handwashing system and identifying areas for improvement within the system. Effective systems strengthening requires a leadership team with strong communications capabilities and understanding of the networks within a system. Mapping the system is necessary to understand the system and identify the groups involved and their relationship to each other. Also, catalyzing collaboration and building social capital are important elements of strengthening the system. He concludes his presentation by stating the importance of understanding the system building blocks and leveraging the appropriate frameworks and tools to catalyze collaborative action within a system to achieve the common goal of handwashing scale up.

Hygiene Behavior Change at Scale in Vietnam

Lilian Pena and Claire Chase of the World Bank provided a practical example of a systems approach in Vietnam. The project aimed to achieve at-scale outcomes for handwashing, taking a comprehensive approach by creating demand for hand hygiene, strengthening the supply chain, and improving the enabling environment (shown below).

The program also considered key drivers and embedded hand hygiene behavior change into complementary activities. They also used incentives to achieve results, utilizing investment costs for water supply which is tied to behavior change outcomes. Intrinsic incentives also played a key role with local leaders who received recognition for their achievements toward hand hygiene. Ultimately, key takeaway from the program included the need to have clear implementation arrangements and coordination, sufficient budget, monitoring and evaluation, and the ability to adapt and innovate.

Nigeria’s National Hygiene Promotion Strategy

Ms. Kogbara Ayaba, the Chief Scientific Officer of Nigeria’s Federal Ministry of Water Resources, discussed the development and implementation of Nigeria’s National Hygiene Promotion Strategy. The Federal Ministry of Water Resources with the support of multiple stakeholders developed the National Hygiene Promotion Strategy as well as guidelines for hygiene prometon in communities and schools. The strategy supports people across the country in sustaining hygienic behaviors and brings high visibility to hygiene promotion activities. The strategy defines the roles and responsibilities of various stakeholders from all levels of the system, including various ministries, state and local governments, as well as private sector and civil society actors. The development and implementation of the strategy engaged multiple partners to ensure hygiene was scaled up in the country.

Hand Hygiene for All Global Initiative

To close out the presentations, Ms. Joanna Esteves-Mills, the Global Coordinator for the Hand Hygiene for All Initiative, discussed a systems approach toward hand hygiene for all. The combination of heightened need and insufficient global coverage, coupled with concerns for the sustainability of gains made during the emergency response phase, led to the birth of the Hand Hygiene for All Initiative. The initiative is co-led by UNICEF and WHO in partnership with several core partners, including the Global Handwashing Partnership.  The initiative considers key elements for hand hygiene scale up. Similar to the elements showcased through World Bank (above), the initiative focuses on access to hand hygiene products and services, evidence-based behavior change interventions, and a strong enabling environment. These elements are embedded in strong political leadership at all levels to champion hand hygiene.

At a global level, the initiatives seeks to develop a case for hand hygiene by standardizing indicators, monitoring tools and methodologies. At a country level, partners are working toward multisectoral roadmaps to improve and streamline their monitoring of hand hygiene. In Ecuador for example, the Ministries of WASH and Education worked together to perform a comprehensive needs assessment across all schools and developed a coordinated plan, including institutionalize handwashing in schools. These efforts allowed schools to reopen safely in the midst of COVID-19. Beyond the COVID-19 pandemic, it is important to leverage the momentum gains for handwashing and bridge short-term response efforts to long-term prioritization. Ultimately, the initiative seeks to work with existing initiatives to elevate handwashing at a systems level.

Key Takeaways

Following the presentation, there was a moderated panel discussion to dive deeper into the topics highlighted. Key takeaways from the webinar include:

• It is important to adopt systems thinking. A holistic approach is needed to address handwashing with soap in a sustainable way. Understanding the connections among multiple actors and their interrelated motivations and challenges can stimulate collective action toward a common goal.
• Systems are dynamic. Stakeholders should consider changes from the perspectives of the many actors in the system. Reflection and learning allows stakeholders to refine the systems approach and to consider changes in conditions for handwashing behavior or changes in the system itself.
• Develop methods for accountability. Accountability mechanisms should facilitate critical reflection on whether the system is working well or if adjustments are needed.

Watch the full recording below.

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