The first line of defence

Global Handwashing Day, celebrated on October 15 every year, is a reminder that human hands are a critical vector for transmitting disease-causing microorganisms. The cross-transmission of these organisms from one person to another occurs when people fail to wash their hands effectively. This year’s theme ‘Hand Hygiene for All’ calls for making hand hygiene a reality for all.

Global response to the Covid-19 pandemic has highlighted this more than ever before. Handwashing has proved to be one of the most effective ways to prevent and control the spread of the coronavirus. According to the US Centers for Disease Control (CDC), handwashing with soap and water for at least 20 seconds is the first line of defence in stopping the spread of infection.

Handwashing is a straightforward preventive measure that most people can do independently; however, unavailability of proper handwashing facilities remains one of the barriers to achieving universal handwashing.

According to the 2017 WHO and Unicef Joint Monitoring Programme (JMP) report, more than 40 percent of the world`s population lack access to basic handwashing facilities. This has impacted the health of over 1.8 million children under five years of age, who die from diarrheal diseases and pneumonia.

In Pakistan, more than 80 million people lack access to handwashing stations with clean water and soap. Over 20 million people in Pakistan do not wash their hands with soap and water at critical times. In institutions like schools and healthcare facilities, hand-washing facilities are either missing, inadequate, not functional or not inclusive.

Diarrheal diseases contribute at least 14 percent of the total deaths annually affecting mainly under-five children. Lack of handwashing is also associated with the high stunting rate (40.2 percent) in the country which is again linked to repeated episodes of diarrhoea impacting a child's cognitive skills for the entire life.

The benefits of proper handwashing are well documented. The simple act of regular handwashing with soap can reduce the likelihood of Covid-19 infection by 36 percent while reducing the risk of diarrheal diseases by 30-48 percent. Handwashing also plays a vital role in reducing the transmission of outbreak-related pathogens such as cholera, Ebola, shigellosis, SARS and hepatitis E. Hand hygiene is protective against healthcare-associated infections and reduces the spread of antimicrobial resistance. Additionally, hand hygiene may contribute to the reduction of Neglected Tropical Diseases.

Today, as we highlight the importance of handwashing, we must also reflect on the inequalities which exist between the poor and the rich if we are to achieve hand hygiene for all. The 2017 JMP showed that basic handwashing coverage among the wealthiest wealth quintile was at least twice as high as coverage among the poorest quintile.

On the Global Handwashing Day, Unicef eulogises the government of Pakistan for initiating the Clean Green Pakistan Movement with hygiene as one of its key pillars. The slogan, ‘Leave no one behind’ adapted from the Sustainable Development agenda, has the ambition of reaching out to every citizen in Pakistan.

As the Ministry of Climate Change leads this initiative, Unicef has adopted a multi-faceted, society-wide approach responding to the Covid-19 pandemic. First, and foremost, it supported the government in providing access to sustainable hand hygiene services including handwashing facilities, regular water supply, soap or alcohol-based hand rub in high-risk areas which included designated Covid-19 healthcare facilities. Second, Unicef supported community engagement and hygiene promotion activities aimed at addressing the full range of drivers to support optimal hand hygiene behavior. And finally, it worked with the Ministry of Climate Change, WHO and other developmental partners to develop WASH-IPC Standard Operating Procedures.

Moving forward, we stand committed to to assist in rolling out the roadmap for Pakistan`s Hand Hygiene for All. The focus will be to ensure that handwashing policies and programs are inclusive to all individuals at all levels. Efforts will be focused on establishing accessible and appropriate places to wash hands in homes, schools, workplaces, health facilities, and other community spaces. Lastly, Unicef will support further research in the field of handwashing inequities in different settings to guide the establishment of inclusive Water, Sanitation and Hygiene policies.

One of the key lessons learnt while responding to the Covid-19 pandemic is that hand hygiene plays a critical role in mitigating disease transmission. All stakeholders, public and private, should therefore ensure hand hygiene for all, across all public and private settings to counter the pandemic. Building on the momentum of handwashing established during Covid-19, the government and its development partners should make hand hygiene a mainstay in public health interventions and create a culture of hand hygiene for all times to come.

The writer is Unicef’s representative in Pakistan.