Hand hygiene in a changing water world: ensuring “water and sanitation for all” in the context of a pandemic

Abstract:

The current COVID-19 pandemic makes us acutely aware how crucial access and ability for adequate hand hygiene are for reducing transmission risks of communicable diseases. Good hand hygiene is critical to protecting your health and those around you. Indeed, regular and thorough handwashing is promoted as one of the most important contributions individuals and households can make to reducing transmission of diseases, including COVID-19.

Advice to ‘wash your hands’ thoroughly may seem easy to follow, yet millions globally cannot reliably access the water and soap necessary for handwashing. Moreover, more frequent handwashing places further demands on already limited water supplies, exacerbating the challenges faced by communities in water scarce areas. Climate change, population growth, and displacement of people present additional challenges by altering water availability, accessibility, and demand.

It is estimated that 40% of households lack access to basic handwashing facilities. In an effort to generate higher-resolution data on challenges with water access and use, the Household Water Insecurity Experiences (HWISE) Scale was implemented among 8,081 randomly selected households across 23 low- and middle-income countries. Nearly one in four surveyed households were unable to wash their hands in the prior month. These challenges, however, are not unique to low- and middle-income countries. Indeed, many poorer families in high-income nations experience similar water, sanitation, and hygiene problems.

In the spotlight of the current COVID-19 pandemic, we explore the challenge of hand hygiene in a changing water world and reflects on the importance of making rapid progress towards “ensure availability and sustainable management of water and sanitation for all” (UN Sustainable Development Goal 6). We contest that solutions to combat the spread of infectious disease, including COVID-19, must consider household water insecurity, that is water availability, quality and, accessibility. Drawing on the latest evidence, we provide recommendations on how to increase handwashing, and improve human health and wellbeing more broadly, by reducing water insecurity.