The case for investing in hygiene

Akshaya Ayyangar | Updated on May 20, 2020

Many policy documents that include hygiene promotion and behaviour change activities have been put out but these have not translated to enough investment on the ground

As the world grapples to check the spread of Covid-19, handwashing with soap is ubiquitous. It is in social media challenges, multi-media campaigns, international and national guidelines, advertisements on the tele, daily news bulletins by heads of state and in newspaper columns. Indeed, one could argue that this has been the largest concentrated effort to drive home the message on the importance of hygiene to maintain good health and well-being. While the current emphasis on hygiene is more than welcome, we must ask ourselves why we needed a worldwide pandemic in 2020, to put the spotlight on hygiene when the impact of good hygiene practices is well-known and well-documented.

The UN (particularly UNICEF), WHO and a few development agencies such as USAID have been promoting safe hygiene practices including handwashing with soap since the early 2000s, because they saw that it was a very effective and an inexpensive method of reducing incidence of diseases such as diarrhoea, related diseases like cholera and respiratory illnesses. Not surprisingly, the UN also declared October 15th as Global Handwashing Day in 2008 to “increase awareness and understand importance of handwashing with soap”.

While countries such as India (Rural Sanitation and Hygiene Strategy 2012-2022) and Bangladesh (National Hygiene Promotion Strategy for Water Supply and Sanitation Sector, 2012) have put out policy documents that include hygiene promotion and behaviour change activities, these have not translated to enough investment on the ground. Especially from international financial institutions such as the World Bank and the ADB, development agencies, international and local NGOs, and others.

Aid commitment to the hygiene sector remained insignificant towards the end of the Millennium Development Goals (MDG) period, according to UN’s Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS), published in 2014. The report states that only 11 countries were able to separate hygiene promotion expenditures from general WASH and health budgets and, of these, only seven countries reported expenditure on hygiene that was greater than $1 million. And, India was not one of them. While targets were included for water and sanitation, and not including hygiene when the 2010 human right to water was amended to include sanitation in 2015, could have played significant roles in the neglect of the hygiene sector that we are witnessing today.

Target for handwashing

The Sustainable Development Goals (SDGs) rectified one wrong by including a target for handwashing with soap, although within the definition of safely managed sanitation facilities. However, this move has not yet led to a significant increase in reporting hygiene data, with regional estimates (except for the sub-Saharan region) on access to a basic handwashing facility not being available for most countries (including India) five years after they committed, due to lack of data.

In fact, the 2017 GLAAS report reveals that only six countries (Bangladesh, Bhutan, Guinea, Kyrgystan, Senegal and Serbia) provided disaggregated expenditures for hygiene from their WASH (water, sanitation and hygiene) expenditures. This is a significant reduction from 11 countries reported in 2014 and suggests that investments in the sector have not increased as they should have.

To understand why there is such a significant gap between policy and action on the ground, it might be worthwhile to look critically at who implements policies, especially in the global south and how this has been done. Almost all the developing countries are heavily dependent on international financial institutions such as World Bank/Asian Development Bank/African Development Bank, multilateral agencies like the UN, international NGOs like Water Aid, bilateral agencies like USAID, DIFD and foundations like the Bill and Melinda Gates Foundation for implementing WASH programmes and projects.

Yet, for the “big funders” like World Bank and ADB, hygiene does not seem to be a priority. In India (despite the country’s commitment to hygiene visible in its policies and programme guidelines), from 2000 till the present, the World Bank has not funded even one exclusive hygiene project. Only four projects (water supply and sanitation projects) have included hygiene interventions — and even these have been restricted to small scale school education programmes, taking up an insignificant portion of project budgets. ADB has funded no hygiene projects, whether exclusive or part of larger water supply and sanitation projects.

Unfortunately, it is unlikely that the Banks’ investments in hygiene will improve over the next few years, judging by their country strategies for 2018-2022. ADB’s strategy does not even mention hygiene while the World Bank’s strategy has a passing mention of improving hygiene practices in the context of children’s development. They continue to focus on large scale infrastructure projects in the WASH sector. This is surprising, considering their claim of aligning their programmes and projects with country policies and goals.

Reduce impacts of pandemics

Other donors such as international and local NGOs, bilateral agencies, foundations and trusts seem to be more committed to investing in hygiene infrastructure, promotion and related activities. Water Aid is one such NGO explicitly committed to the cause of good hygiene in India.

In the next few decades, to prevent and reduce impact of such kinds of pandemics, and other existential threats such as climate change, terrorism and so on, which are destroying communities and forcing mass migration, substantial investments in hygiene is vital. For a start, large lenders such as World Bank and ADB must rethink their WASH investment strategies. Experience from their own projects as well as other government programmes such as the Total Sanitation Campaign and the Swachh Bharat Programme, have proven that large scale engineering solutions alone are not enough to achieve WASH goals in the long run.

WASH, especially the ‘SH’ (sanitation and hygiene), are inherently linked to social and cultural practices and behaviour which require more nuanced approaches. Equal investments or more are required in understanding and building social capital and social infrastructure which determines how, why/why not and when toilets, handwashing stations and water infrastructure are used.

Multilateral, bilateral and international organisations are in perfect position to be the catalysts and can influence other organisations to follow suit, by leverage their existing relationship and strong networks within national and State governments. It’s no longer enough to focus on water and/or sanitation alone. Hygiene must be an integral part of water supply and sanitation projects, commanding a significant portion of programme and project budgets, if we wish to achieve the SDGs not just on paper.

The writer is passionate about solving WASH issues and works at the Chennai Resilience Centre and Okapi Research & Advisory, Chennai

Published on May 20, 2020

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