There are a number of things, which hygiene stakeholders can do in light of the COVID-19 pandemic, including:

  • Advocating for handwashing investment (both hardware and software)

  • Collecting better cost data for existing hygiene programmes to build a better case for such investment

  • Context-specific advocacy linked to local priorities

Advocate for handwashing investment

Hygiene stakeholders can draw attention to studies showing that:

  1. handwashing programmes can deliver a $2 return on a $1 investment, or substantially more with high levels of uptake and adherence

  2. handwashing programmes have similar cost-effectiveness to that of immunisation and oral rehydration therapy

In most countries, far more time, effort and money is spent on immunisation than on hygiene promotion. Substantial plans, budgets, and policies exist for vaccination programmes whereas these are lacking for hygiene programmes. Furthermore, vaccination programmes are typically undertaken on a rolling basis with dedicated budgets and staff, while few hygiene programmes are designed with sustainability in mind.

Collect better cost data

In comparison to other interventions in water supply or sanitation, there is very little evidence on the costs and the return on investment for hygiene programming. Information about costs is useful not only for informing the modelling of return on investment, but also for justifying, developing plans or prioritising intervention strategies for similar or other country settings. Actors can improve the state of knowledge by collecting data on the costs of their programmes and interventions. These can be shared publicly, or can be studied in partnership with researchers to ensure better understanding of intervention costs in the future.

Context-specific advocacy linked to local priorities

There are useful toolkits for advocacy that provide general guidance, as well as specific strategies for hygiene. The most effective advocacy is based on a strong analysis of what the problem is, who has power to change things, and which levers to pull to influence those people. This could involve an analysis of why hygiene is currently neglected and identifying who within government, civil society, donors or the private sector may be in a position to strengthen their focus on hygiene. It may be wise to link hygiene advocacy to domestic political and economic priorities. Arguments will be more persuasive if based on local or regional data and examples. Advocacy can also help actors appreciate the range of health and wellbeing benefits of handwashing, and to highlight how hygiene plays a key role in the prevention of future outbreaks. Policy briefs produced by the World Bank’s 'Economics of Sanitation Initiative’, while focused on sanitation and now slightly outdated, can provide some useful materials and data. Undertaking an internal cost-benefit analysis may seem daunting, but WHO guidance and reference case methods exist on how it can be undertaken. Recent data on handwashing facilities in households, schools and health facilities can be found from WHO and UNICEF here. Data on diarrhoeal disease morbidity and mortality can be found here. Other useful contextual data about diarrhoeal disease and acute respiratory infections can be found in Demographic and Health Surveys which exist for many countries.

When conducting advocacy on the need for hygiene promotion, it is useful to combine economic and health data with other types of information that can show the ‘full value and experience’ of hygiene. This should include capturing the experiences of community members who have benefited from hygiene programmes. Sharing examples of how other neighbouring countries have improved the state of hygiene can also inspire governments and communities to take greater action. This report from WaterAid captures hygiene progress across Southern Africa and makes direct comparisons between different countries in order to spark policy change.

Want to learn more about the economics of hygiene programmes?

Editor's Note

Author: Ian Ross
Review: Marc Jeuland, Guy Hutton, Robin Lloyd
Last Update: 15.12.2020

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