‘Hand to mouth’ existence

Global Hand Washing Day is celebrated on October 15 every year. Since 2008, millions of children in thousands of schools across the country have marked the day by washing their hands with soap following a carefully demonstrated procedure. However, little is done beyond this day to inculcate the habit. This is due to a lack of interest among teachers, poor hygiene education and absence of soap, water and a place to wash.

Hand-washing is the single most effective preventive for diarrhoea and acute respiratory infections, leading killers of children worldwide. Studies by different agencies and the Government show washing hands at the correct time can prevent 47 per cent of the cases of diarrhoea and prevent a quarter of the resultant diseases. It can also cut the risk of respiratory tract infections by a third. As published in The Lancet , additional research indicates that washing hands with soap can reduce the risk of diarrhoeal diseases by 42-47 per cent and interventions to promote hand-washing might save a million lives.

However, people do not wash their hands with soap; in most households, soap is available but used for bathing and washing clothes. To be effective, this activity must be performed with ash or soap. Dirt will not do since it does not increase the cleaning efficacy of water and may well be contaminated with faecal matter, given that in India, some 620 million defecate in the open.

Even though washing hands after defecating and before cooking or eating sounds like common sense, most people do not wash their hands with soap or ash. This leaves them and their children more vulnerable to disease. Studies have recorded many different occasions for hand-washing by child carers, children and adults. They found that washing after stool contact was relatively rare; after cleaning a child, it was 13 per cent; for the carer after defecation it was 14 per cent. This is significant since children are an important reservoir of diarrhoeal pathogens and the carer is often the person who prepares and serves food.

A technical note by WaterAid says pathogens enter a person’s mouth from unwashed hands directly and indirectly if the person has touched stools. Children are especially vulnerable. Pathogens can enter through food and water that has been handled with unwashed hands.

Schools are the best place to promote hand-washing with soap. The mid-day meal programme that caters to 120 million school children, is an important vehicle for promoting hand washing with soap. This is reiterated by the Ministry of Drinking Water Supply (MDWS) that has promoted hand-washing with soap as a key hygiene practice. In the current sanitation campaign, school sanitation has been handed over to the Ministry of Human Resource Development.

These hygienic practices, once learnt in school, can be inculcated into household hand-washing with soap practices. A study with a sampling of schools showed about 42 per cent of school children are aware of the need to wash hands with soap, but only 12 per cent of schools have soap available. Even hand-washing stations with water are in short supply.

In recent years, there have been several attempts to inculcate the habit. In Assam, the Public Health Engineering Department (PHED) and Unicef worked with the North-East Diocesan Social Forum in 11 districts. In Tamil Nadu, Gramalaya mounted a campaign with WaterAid and Water.org in three blocks of the Tiruchirapalli districtIn Orissa, an NGO called Udyama organised a hand-washing event for 200 children and 15 parents and teachers. Another NGO, Pragati, held another event covering 650 students and 30 students. The Madani Welfare Association covered 5,000 people, eight schools and 15 villages. In Jammu, the Society for Popularisation of Science and Progressive Educational Society took up the issue. In Bhopal, the Madhya Pradesh the Energy Environment and Development Society along with Unicef developed a mobile unit approach to create mass awareness. This year, WaterAid India as part of its technical assistance to the Government of Madhya Pradesh aims to get 2.3 million children in 19,000 schools of the State to wash their hands in one hour. The challenge will be sustain the momentum created through the year.

The writer heads the policy advocacy and research wing at WaterAid India

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