Small investment equals big changes – handwashing devices matter

Handwashing with soap is an easy, effective, and affordable do-it-yourself preventive measure against several infectious diseases, including Covid-19. It breaks the vicious cycle of diarrhoea and malnutrition and can substantially reduce under-five mortality. 

Every year, about 1.8 million children under the age of five die from diarrhoeal diseases and respiratory infections like pneumonia. The simple act of washing both the hands with soap in critical times can reduce global under-five mortality due to diarrhoea by almost one-half and acute respiratory infections by nearly one-quarter. 

The benefits of handwashing are not just limited to children but also extend to adults as well. It is estimated that good handwashing practices can reduce incidences of diarrhoea and respiratory illnesses in the general population by up to 40 percent and 21 percent respectively, leading to huge economic benefits by increasing productivity and reducing cost of treatment. Handwashing can greatly reduce the spread of communicable diseases and there is no denying that it is a life-saving intervention against Covid-19. Handwashing with soap has been recognised as one of the most effective inventions in the domain of public health. 

Since the onset of Covid-19 in Bangladesh, the entire country has been flooded with the primary message of "frequently washing hands for at least 20 seconds" following the advice from the World Health Organisation (WHO). The media played a dynamic and vital role in promoting handwashing with soap and disseminating this core preventive message across the country.  

The government has also highlighted handwashing with soap in its official Covid-19 messages, but these seem to have been crowded out by other Covid-19 messages. However, it is encouraging to note that almost all local and multinational companies producing soap, hygiene and cleaning products have tailored their advertising in line with Covid-19 messaging. 

Appreciating the whole-hearted efforts from all corners, one of the critical observations is majority of the promotional materials contain visuals showing running water representing the urban context. This can lead to more than 63 percent of people in Bangladesh living in rural areas to feel excluded. 
Most of the rural population in Bangladesh use different types of hand tube wells. In many places where tube wells are not technically feasible, people use several types of community-managed waterpoints mainly for drinking and other domestic purposes. Rural inhabitants often carry water from waterpoints or nearby water sources like ponds to latrines for washing hands after defecation. 

Even in urban slums and low-income communities, water is available only at community-managed waterpoints having extended connection from water utilities or typical tube wells depending on context. People preserve water in their kitchens or other suitable places in their households for washing hands before or after eating.

Covid-19 has recently changed the whole notion of handwashing. People have now started washing hands even in rural markets, health complexes, local government office premises and after returning home. This is definitely a positive development, but we also need to be cautious about the risk of transmission from waterpoints. People touching handpumps or using mugs to draw water from buckets can further spread the virus. 

Moreover, use of tube wells or mugs require one hand to pour the water. This is not only inconvenient but may also be counterproductive as the cleaned hand is then used to pour water by touching the handpump or another surface which could be contaminated. In densely populated urban slums, people require handwashing at entry and exit points to reduce spread of Covid-19, and this is difficult due to a lack of adequate and appropriate facilities.

Considering these facts, WaterAid Bangladesh stepped into designing simple, context-specific and affordable handwashing devices with running water for both public places and households with support from its partner NGOs, enthusiastic social workers and local entrepreneurs. A wide variety of handwashing devices has been promoted during Covid-19 for both rural and urban contexts to enable the most deprived communities to wash hands easily with running water.

While promoting handwashing devices, several innovative and low-cost models have been developed like Tippy tap, tap attached with a barrel or clay pot and many others. Many of the low-cost models also came out from the imagination of local inventors together with WaterAid and its partner NGOs. WaterAid compiled around 20 different types of handwashing devices in an "easy-to-use" manual with essential description and cost estimation so that people can set up handwashing devices according to their own context. 

The handwashing devices mostly require locally available materials like taps, clay pots, buckets, drums, stainless steel/mild steel frames, plastic products, basins, pipes, water tank etc. Use of locally available materials and accessories are making these devices more affordable. One of the best innovations is the introduction of contactless pedal type handwashing device which allows people to wash hands without touching the tap, thereby minimising the risk of spread of infection and reducing wastage of water. 

There are also handwashing devices which allow children and people with disabilities to access and use the facilities easily. People in hard to reach rural areas can also make their own hand washing devices at their yards using tap attached to a mini drum/earthen, pot plastic bowl to collect used water, and fixing this simple system using mud. Tippy Taps are very simple handwashing devices that are also useful in rural Bangladesh. 

WaterAid has made this "easy-to-use" manual publicly available and shared it widely with WASH sector actors. Several organisations and individuals have already reached out and proactively started using the suggested designs for developing handwashing devices using their own resources. WaterAid has also developed a design specification for public handwashing stations to encourage best practices in handwashing design. 

Covid-19 has shaken the world with fear and uncertainty whereas a very basic and simple strategy of frequently washing hands with soap can challenge the devastation of this pandemic. According to the WHO, an investment of only $3.35 in handwashing promotion is estimated to deliver the same amount of health benefits as a $11 investment in latrine construction, or a $200 investment in household water supply. These figures illustrate how a small investment equals big changes, even though it remains neglected by individuals, communities, institutions and policymakers.  
 
Handwashing with soap should not be continued due to Covid-19 fears, rather it should be developed as a lifelong habit. The time has now come to redefine the investment paradigm at individual, community and even the national level to make sustainable changes for humanity to exist under a "new normal" situation.

Hasin Jahan is Country Director of WaterAid Bangladesh, Golam Muktadir is Technical Adviser of WASH, and Zarif Ifthekhar Rasul is Strategic Support Officer of WaterAid Bangladesh.