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Handwashing - A Lifesaver Too Many Have Had to Live Without: OpEd

By Dr. Adaeze Oreh (Guest Writer)

Two million, sixty-seven thousand, nine hundred people — that is the number of persons currently infected with the new coronavirus as at publication, and every day that number steadily climbs, sending countries and people across the world into fear and panic.

Ever since COVID-19 came on the world’s stage in December 2019, one recurring message has been that one of the most effective ways of preventing its spread is by frequent handwashing with water and soap. From the World Health Organisation (WHO), to the United States Centres for Disease Control (CDC), the United Kingdom’s National Health Service (NHS), and the Nigeria Centre for Disease Control (NCDC), that singular advisory has rung out. Wash your hands frequently and thoroughly with water and soap to prevent infection with COVID-19. Unfortunately, for a huge proportion of the world’s population, clean water is a luxury they can hardly afford.

In fact, according to WHO and UNICEF, up to three billion people worldwide lack basic handwashing facilities at home — that is two out of every five people on earth who during this global pandemic of COVID-19 have no access to water and soap in order to protect them from this highly infectious and potentially severe virus.

Image credit: Nigeria Health Watch

While the initial phases of the spread of COVID-19 have been occurring in developed regions such as China, Italy, France, Spain and the United States of America, cases are exponentially increasing in less developed parts of the world and affecting countries that have an inequitable burden of lack of water and access to basic sanitation. In these regions, majority of the populations live in rural and remote locations, urban areas are densely populated, and years of conflict and insurgency have resulted in disproportionately high numbers of people living in internally displaced persons and refugee camps.

In Nigeria, the most populous country in sub-Saharan Africa, poor access to improved sources of water and basic sanitation facilities is a major contributing factor to high sickness and death rates among children below five years. In fact, exposure to contaminated drinking water and poor sanitary conditions leads to deaths of more than 70,000 children under five every year. To top it all off, the country is now the open defaecation headquarters of the world — with nearly 25 percent of its population defaecating openly due to a lack of sanitary facilities.

Image credit: Nigeria Health Watch

Findings from a recent report released by the United Nations and WHO showed that less than 15 percent of countries worldwide had invested sufficiently in effective water, sanitation and hygiene (WASH) systems.

The current pandemic of COVID-19 has clearly highlighted the need for investments in clean water and sanitation around the world. Recently, Action Aid, an international charity that works with people living in poverty and exclusion, partnered with Unilever to launch a $122 million campaign targeting one billion people globally through handwashing campaigns and the distribution of hygiene products, including soap.

For a very long time, issues relating to social determinants of health such as water, sanitation and hygiene have been ignored. It is little wonder the world is seeing an increase in re-emerging infectious diseases perpetuated by lack of access to clean water and poor hygiene and sanitation — diseases like COVID-19, Lassa fever and influenza.
We must begin to correct this inequity by ensuring that WASH facilities are prioritised not only in developed countries but in developing countries as well, not only in urban cities but in rural communities also.

The provision of equitable access to water, sanitation and hygiene services must no longer be deemed a luxury, but a necessity that should be accessible to all regardless of socioeconomic status. Photo credit: Nigeria Health Watch

First, the provision of equitable access to water, sanitation and hygiene services must no longer be deemed a luxury, but a necessity that should be accessible to all regardless of socioeconomic status. However, in the dissemination of preventive messaging on frequent handwashing, the delivery has been directed at those with adequate water sources and does not speak to those challenged by a lack of readily available water. Broadening the messaging to offer less than ideal but possible alternatives acknowledged by the WHO such as chlorinated water, rainwater and even ash and clay in the absence of soap would help drive the importance of handwashing and build a culture of practice in communities where water and soap are unavailable.

Second, state and local government councils must prioritise the need for adequate WASH services in communities. This means increasing investments in effective WASH systems and ensuring that the legal frameworks necessary for their development, implementation and uptake are in place and equitably distributed, particularly in IDP camps. It is unacceptable that given the spread of COVID-19, 40 percent of health care facilities in the world are not equipped to practice hand hygiene at points of care.

Hygeine in schools is critical for children, and more schools need to have access to basic handwashing facilities, like these ones provided to a school in Enugu by an NGO, PACIEH. Photo credit: Nigeria Health Watch

Third, governments, private organisations and international donors should develop public-private partnerships directed at developing innovative solutions and ensuring sustainable water services especially in rural communities. Social impact organisations such as Majik Water in Kenya are using technology to extract moisture molecules from the air in communities with high levels of humidity, making safe water available. Another organisation — Tarun Bharat Sangh in India — works with communities to harvest rainwater for sustainable water solutions and trains community leaders on water management. Partnerships with organisations such as these would enable them to scale their technology and expertise to make clean water more widely available.

Handwashing with soap is one of the most effective barriers to the spread of diseases. Photo credit: Nigeria Health Watch

Unarguably, handwashing with soap is one of the most effective barriers to the spread of diseases. The globe recently celebrated World Water Day. Such a basic necessity has not been available to so many for so long, but we can take deliberate and innovative steps to ensure everyone has access to readily available and safe water.
 
Do you know communities and health facilities where access to handwashing points is lacking? What innovative interventions to increase access to clean water have you seen in Nigeria? Let us know on our social media platforms: @nighealthwatch on Twitter and Nigeria Health Watch on Facebook.
 
Author’s Bio: Dr Adaeze Oreh is a Senior Health Policy Advisor and Family Physician with Nigeria’s Ministry of Health, with over 17 years’ experience in healthcare service delivery and management across public and private sectors. She is also a Senior Fellow for Global Health with the Aspen Institute and currently serves as Public Relations Officer for the Society of Family Physicians of Nigeria FCT Abuja and Keffi Zone.

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