The COVID-19 pandemic offers the opportunity to build resilience in rural areas against future outbreaks and reduce the enduring burden of diarrhoeal diseases, respiratory infections and Neglected Tropical Diseases. The public messaging and prioritisation of handwashing and hygiene practices during the pandemic has highlighted that more needs to be done to meet the Sustainable Development Goals (SDGs) related to water, sanitation and hygiene (Goal 6). The pandemic has led the WHO and UNICEF to create a new Hand Hygiene For All initiative which sets out a plan for how we should respond to COVID-19, rebuild after the pandemic and reimagine the state of hygiene globally. Within this it is acknowledged that changing the state of hygiene and building resilience against disease, requires a coordinated and strategic approach combining:
Advocacy actions to influence national policy
Large-scale local-level action to create normative change
Financial and infrastructural investment to create an enabling environment
Research, learning and monitoring of programmes to improve the quality of implementation.
The Hand Hygiene for All initiative also highlights that action needs to happen within a range of settings including:
Health care facilities
Schools and day-care centres
Workplaces and commercial buildings
Refugee, migrant and other camp-like settings
Prisons and jails
Markets and food establishments
Transport hubs, places of worship and other public spaces
Long-term care facilities
This larger framework is particularly relevant for thinking about resilience building in rural areas because these regions have historically been harder to reach with WASH services, infrastructure and programmes. For example, we now have the opportunity to advocate for funding to support creative and sustained handwashing behaviour change work at a national level. The renewed emphasis on comprehensive infection prevention and control (IPC) practice at health facilities, has created an opportunity for rural health service stakeholders to advocate for dedicated funding to operationalise and maintain WASH infrastructures to sustainably support recommended IPC and hygiene activities for both staff and users of rural healthcare facilities. The COVID-19 pandemic may create opportunities to improve rural water services through fixing broken infrastructure, constructing new water points, and providing increased training for maintenance and construction.