2022 Fact Sheet

GLOBAL HANDWASHING DAY

unite for universal hand hygiene

Global Handwashing Day (GHD) is a global advocacy day dedicated to increasing awareness about the
importance of hand hygiene and triggering lasting change from the policy-level to community-driven
action.

Unite for Universal Hand Hygiene

The 2022 GHD theme is Unite for Universal Hand Hygiene. Joint action and collaboration are essential
for successful and sustainable hand hygiene strategies. This year’s theme calls for governments, donors,
businesses, institutions, researchers, and advocates to unite in action to achieve the goal of hand hygiene
for all. This fact sheet summarizes the latest evidence to address hand hygiene at a systems-level -
including national hand hygiene policies, the economic case for universal hand hygiene, and hand hygiene
equity – translating the latest evidence into advocacy messages and programmatic actions to guide your
future hand hygiene work.

What are the benefits of hand hygiene?

Hand hygiene can help reduce the transmission of a range of diseases:

Handwashing with soap can reduce diarrheal diseases by 30%.

Handwashing with soap can reduce acute respiratory infections by up to 20%.
Handwashing with plays an important role in reducing the transmission of outbreak-related pathogens
such as cholera, Ebola, shigellosis, SARS, hepatitis E, and COVID-19.
Hand hygiene is protective against healthcare-associated infections and reduces the spread of
antimicrobial resistance.
Hand hygiene may contribute to the reduction of Neglected Tropical Diseases.

Handwashing has also been linked to benefits beyond disease reduction, such as reduced rates of school
absenteeism and recently, programs aimed at encouraging older children to perform regular handwashing
in school have been central to safe school-reopening strategies and preventing school closures.
The ability to regularly practice handwashing is also thought to contribute to improved wellbeing, dignity,
educational fulfilment, and productivity.

Key Advocacy and Action Messages

Handwashing is key to reducing the burden of many diseases which pose chronic challenges to health
and development.
Handwashing plays a key role in the control of infectious-disease outbreaks.
Handwashing is also important to achieve benefits beyond disease reduction, such as increased school
attendance and enhanced dignity.
Advocates should raise awareness on the importance of hand hygiene as an essential part of health
and wellbeing.

A Systems Approach to Hand Hygiene

Achieving universal hand hygiene in a country is a complex issue and requires collaboration and
coordination between multiple and interconnected actors across all levels of the system (national, state,
community, and institutions). The fundamental elements that allow the system to function and support
handwashing are known as “building blocks.” According to Sanitation and Water for All (SWA) and
further applied to handwashing in the Handwashing Handbook, these building blocks include:

Strengthen the enabling environment for hand hygiene (SWA building blocks)
development
arrangements

Policies and
Coordination

monitoring,
and review
institutional

strategies

Capacity
Planning,
Financing
and

Coordination and institutional arrangements – Formal relationships and mechanisms for

communication, collaboration, and coordination among the key actors in the country, which include
the private sector, civil society organizations, faith-based organizations, funders, and government
entities across different ministries, from the community to the national level.
 Policies and strategies – Mechanisms by which a government sets out its vision (policy) and
determines its plan of action (strategy) for hand hygiene. National policies should identify targets to
improve handwashing infrastructure and provide guidance on strategies and institutional
arrangements for achieving those targets.
Financing – Realistic, transparent budgets with funding dedicated for hand hygiene. Countries with
established national hygiene policies and plans should cost plans and ensure that financial and
human resource needs will be met for implementation of the plans.
Planning, monitoring, and review - Systems for monitoring, evaluation, and review of national hand
hygiene plans and targets. These systems should enable assessment of progress toward the uptake of
handwashing and support planning for adjustments in programs to optimize scale-up.
Capacity development – Capacity building on formative research, behavior change, and quality
delivery, as well as development plans to address the capabilities of institutions to fulfill roles and
responsibilities at scale, including the availability of necessary structures, tools, training, and
incentives.
Reliant, resilient, and sustainable systems must be built to create an enabling environment in which hand
hygiene can be practiced across homes, schools, workplaces, healthcare facilities and other public places.

Key Advocacy and Action Messages

Countries should adopt a systems approach to hand hygiene which addresses coordination and
institutional arrangements, policies and strategies, financing, planning, monitoring, and review, and
capacity development to create an enabling environment for these actors to operate and collaborate.
Mapping the system should first be undertaken to provide a better understanding of the actors, entry
points, resources, and coordination mechanisms that affect hand hygiene in country, and to ensure
actors understand their role.
Leadership teams should establish strong communications capabilities, as well as a good
understanding of systems strengthening.
Collaboration and coordination between multiple and interconnected actors is necessary to achieve
universal hand hygiene.
Advocacy must motivate and inspire actors in the system to achieve improvements in policy, investment,
planning, and monitoring to support overall systems change.
Equity in Hand Hygiene
Globally, access to handwashing facilities and products remains unequal. Progress for hand hygiene is
monitored by WHO/ UNICEF Joint Monitoring Program for Water Supply, Sanitation and Hygiene (JMP).
While the number of countries included grows each year, many countries only have a small number of data
points around hand hygiene, making it difficult to assess trends.

For people to be able to practice hand hygiene, they need access to hand hygiene facilities that are
conveniently located and easy to use. People are much more likely to wash their hands if they have soap
and water present near the handwashing facility. However, in 2020, only 71% of people had access to a
basic handwashing facility, globally. This leaves 2.3 billion people who lack basic services, including 670
million people with no handwashing facilities at all.

Map showing the availability of basic hygiene services globally, developed by the JMP.

Rates of change in access to handwashing facility has been slow, increasing by just 4% between 2015 and
2020. If current rates of progress continue, by 2030 the world will have reached only 78% coverage of
basic hygiene services, leaving 1.9 billion people without the facilities to wash their hands at home. A 4-fold
increase in access to basic handwashing services is needed to meet the Sustainable Development Goal
(SDG) targets.

Data about access to hygiene in health care facilities is also low, being available for just 71 countries. Of
these, only 50% of health care facilities have basic water access and 74% have hand hygiene services at
points of care. That leaves almost 2 billion people depending on health care facilities without basic
hygiene services.
The world is also not on track to achieve
universal access to basic handwashing
facilities in schools by 2030. Of the 107
countries which have data available on
handwashing services in schools, only 58%
provided basic handwashing facilities and
25% had no service (no facilities or no water
at all). This means that 818 million students
currently have nowhere to wash their hands.
Achieving universal coverage requires a 5x
increase in progress on basic hygiene services.
If current progress continues, one in three
students will lack a basic hygiene service in
2030. Global coverage of hygiene in schools 2015–2021 and
acceleration required to meet targets by 2030 (%), JMP

Key Advocacy and Action Messages

A large acceleration in progress is needed to meet the SDGs and achieve universal hand hygiene by
2030.
Efforts must prioritize reaching the most vulnerable.
Efforts to improve access to at least basic handwashing facilities must focus not only on the community
but across institutions including schools, healthcare facilities, workplaces, and in other public settings.
More data is needed about access to handwashing facilities globally.

National Policies and Strategies on Hand Hygiene

To foster a collaborative effort to achieve universal hand hygiene, it is important to understand what
actions governments currently take to enable hygiene promotion, facilities, and handwashing with soap.

Most countries have national policies and national plans for hygiene in place. Of the 109 countries surveyed
for the 2020 GLASS Report, 79% reported having national policies for hygiene and 73% reported having
national plans for hygiene.
Most of these national policies and plans address promotion of handwashing with soap, including in
schools and healthcare facilities. Despite most countries having national hygiene policies and plans, only
40% have national hygiene coverage targets that align with SDG indicator 6.2.1 (handwashing facility on
premises with soap and water) and over 40% have yet to set a national coverage target for hygiene at all.

The first step for many countries to achieve

hand hygiene for all by 2030 is to develop a
national hand hygiene roadmap, which
identifies strategic goals and opportunities
for investments to improve hand hygiene and
guide actions across three pillars: political
leadership, enabling environment, and
inclusive programming at scale to increase
supply and demand. Roadmaps can align
multi-sectoral stakeholders and investments
around a common, co-developed vision and
course of action.

The five steps to creating a roadmap

include:

1) Engage– Set up or identify existing

coordination mechanisms with all actors Bangladesh’s Hand Hygiene for All Roadmap
relevant for hand hygiene and define the
process, roles, responsibilities, and timelines

2) Assess - Understand the current hand hygiene landscape (context / coverage / stakeholders / funding)
and identify strengths and gaps to be addressed in the roadmap plan

3) Plan - Define actions to build upon existing activities and strengthen hand hygiene across settings

4) Prioritize - Prioritize actions based on set of criteria

5) Cost - Identify costs for each activity

Beyond developing the national hygiene roadmap, next steps should include dissemination and
socialization of the roadmap, implementation and budget planning, operationalization, and monitoring and
evaluation.

Key Advocacy and Action Messages

Alongside polices and strategies, countries must set national coverage targets aligned with Sustainable
Development Goal 6.
Countries should work towards creating costed national hygiene roadmaps to provide guidance and
focus for all actors involved in achieving universal hand hygiene.

Financial Costs of Hand Hygiene

Finally, understanding current resourcing of national hygiene plans and the necessary resource
requirements to achieve universal hand hygiene is essential for planning successful hygiene strategies.

Within national policies on water, sanitation, and hygiene (WASH), hygiene is deprioritized compared to
water and sanitation, comprising only 4% of government WASH budgets. Few countries have sufficient
financial and human resources to implement their national hygiene policies and plans with only 9% of
countries reporting sufficient funds to support their national plans.

Map showing the level of sufficiency of financial resources allocated to hygiene to meet national targets (n=67),
according to the GLAAS report
The costs of hygiene promotion activities are typically born by governments and funders; however, the
responsibility for facilitating hand hygiene largely falls on households and communities. For example, results
from five countries show that household expenditure on hygiene (handwashing facilities, soap and water) is
likely a significant portion of all household WASH expenditure.

Across 5 countries, household expenditure on soap, water and hygiene facilities comprises a substantial proportion of
people’s income, according to the GLAAS Report.

It is estimated that between US$12.2 and US$15.3 billion is needed to achieve universal hand hygiene in
household settings in the world’s 46 least developed countries (LDCs) by 2030. Such expenditure may be
justified on public health grounds since a substantial disease burden could be averted by hand hygiene.
Approximately 42% of this should be allocated to behavior change promotion interventions and the
remainder allocated to soap, handwashing facilities, and water. All households in these 46 LDCs could
have handwashing facilities by 2030 with investment in hygiene totaling less than US$1 per person, per
year.

To meet these costs, resources across government and partners should be mobilized, and businesses should
develop innovative solutions to meet hygiene needs and harness economies of scale to reduce costs.

Key Advocacy and Action Messages

Hygiene should be made a greater priority within national WASH policies and the proportion of funds
dedicated to hygiene should reflect this
Communities and organisations must advocate to governments and other decision makers to fund and
resource hygiene to a level that will allow achievement of the SDGs and ensure hand hygiene for all.