Public handwashing facilities provide an opportunity to do handwashing observations or spot checks while maintaining a safe distance from others (at least 1 metre, or according to national guidelines). Depending on resources available for monitoring, the following options might be possible:
Structured observations at public handwashing facilities
Station a person at the handwashing facility for the whole day or for specific periods during the day to record all handwashing events and if soap is used. This person could be a dedicated M&E staff member from your organisation or it could be a handwashing monitor from the local community who is also in charge of replenishing the water and soap at the station. If the latter, consider remunerating the person for their time and provide training on the observation approach. You may also need to provide them with phone credit so they can report observation results by phone.
During observations at public facilities, the following should be recorded:
The number of handwashing events and whether each individual used water and soap for handwashing or only water.
Water or soap refill events
Age (child or/ adult) and sex of the people using or refilling the facility
Any instances where an individual tried but was unable to wash their hands (with soap), and any observed reason for this
Note that observations can tell us how many handwashing events took place during a specific time period, the age and sex of the people using the facility and whether they used soap. However, it’s unlikely that the observer will be able to remember which individuals visit the facility more than once, so these observations cannot tell you how many different people use the facility and how often. In particular contexts, it may be appropriate to work with local people who can inform you whether the users are from the community or not. Collecting observational data at the same time points throughout the course of an outbreak can be an interesting way of looking at how behaviour changes over time.
Information on the number of visits to a handwashing facility is also useful when a new handwashing station is first installed as it can help guide decisions about how often soap and water will need to be replaced.
Spot checks at public handwashing facilities
An observer can visit the handwashing stand at regular intervals (e.g. once a day at a particular time), to record if there is water and soap available for handwashing. They may be able to work with community volunteers to learn how often soap and water are being replenished.
Note that spot checks can only tell us if there is water and soap available for handwashing, i.e. that there is an enabling environment for handwashing. This cannot tell us how many people use the facility or if it has been refilled during the day.
Measuring physical distancing near public handwashing facilities
This could be done in various ways depending on the context and current guidelines on physical distancing. For each of the suggested actions below it may be necessary to define a physical space (e.g. 10m radius of the handwashing facility) for monitoring.
Count the number of times people shake hands, embrace or come into physical contact.
Count the number of times people gather in groups of a certain number. This number should be based on the local guidelines (this may be difficult to do in a public place)
If physical distancing nudges are placed near the handwashing facility (e.g. marks on the ground indicating the distance at which people should stand), then could count how frequently people breach these.
Ethical implications of observing public handwashing practices
Since it will not be possible to obtain consent from all people being observed at the facility, it is important that observers do not record any names or other identifiable information of the people observed.
To inform people about the ongoing monitoring, one option would be to put up public signs or make announcements using speakers informing people that there is a study going on. If asked, observers can also explain to people that they are counting the number of people using the handwashing facilities and that they are not recording any identifiable information.
If during observations at households or at public facilities, behaviours that are considered unsafe (e.g. not maintaining recommended physical distancing measures) are observed, it is recommended that data collectors remind participants about some key COVID-19 preventative behaviours from a pre-agreed script after observations have ended (so that it does not bias the observations).
Want to learn more about adapting hygiene project outcome measures for COVID-19 response?
Authors: Fiona Majorin and Julie Watson
Review: Deepak Saxena, Katie Greenland, Hans Mosler, Dr Robina Shaheen
Last update: 29.09.2020