Innovation in the air for one of the oldest public health interventions

Digital DiversityWhen you walk up to a sink in a public restroom, there’s a good chance that you’ll be greeted by a poster reminding you to wash your hands. In this installment of Digital Diversity, Layla McCay – a member of our Media and Research Team – talks more about one of the oldest public health interventions as part of the celebrations on this, Global Handwashing Day.

Digital Diversity is a series of blog posts from featuring the many ways mobile phones and other appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives.

By Layla McCay

No matter where you are in the world, the benefits of washing your hands with soap and water are impressive. Worldwide, handwashing with soap can cut the risk of diarrhea in half, and respiratory infections by a quarter. Globally, it can support good nutrition, keep children in school, promote equity, and boost the economy. And, as has become particularly relevant this year, it can help prevent the spread of Ebola. Handwashing is a major international development investment.

And yet, every year 1.7 million children under the age of five die due to diarrhea, pneumonia and other infections that could be prevented by handwashing with soap. There are many reasons people don’t take advantage of the benefits of handwashing, including insufficient knowledge and understanding about its importance; lack of water and soap near the toilet, food preparation or dining areas; or just not getting into the handwashing habit.

A recent Global Handwashing Day event in Washington, D.C. focusing on Exploring New Ideas in Hygiene Integration, Innovations in Handwashing and Insights into Behavioral Drivers was packed full of people who work in international development. They had one question on their minds:  Handwashing is one of the oldest public health interventions – so what’s new in handwashing? It turned out we’re slowly moving beyond those rest room posters. Innovation is underway.

The power and reach of mobile technology is being harnessed to educate women around the world that when they wash their hands with soap after using the toilet or changing diapers and before preparing or eating food, they help keep their children healthy. Unilever Lifebuoy showcased their effective pilot program where expectant and new mothers in India received phone calls with recorded, targeted hygiene messages. Recipients laughed over the ‘baby’s’ voice being used to deliver information, but importantly, they listened – and the suggested behaviors were enacted.

“Whenever I come back from the fields, my wife doesn’t serve food until I wash my hands,” said one new father on the impact of his wife receiving these messages.

Photo courtesy MAMA, copyright © 2014 by Malherbe Pelser
Photo courtesy MAMA, copyright © 2014 by Malherbe Pelser

Mobile phones are also being harnessed by the Mobile Alliance for Maternal Action (MAMA) to improve handwashing knowledge and practices. MAMA’s Senior Communications Manager, Stephanie Bowen, explained how integrating handwashing messages into health information delivered by mobile to mothers in Bangladesh, India and South Africa empowers them to make healthy decisions for themselves and their babies with practical suggestions delivered right into their hands, such as:

“You can help keep your whole family healthy by washing your hands. Set up a washing stand with soap and water near where you prepare food.”

But technology for communications isn’t the only way to innovate in handwashing. People also need physical access to the ‘hardware’ of handwashing- running water and soap. Columbia University graduate student Prerna Seth described a new handwashing station she has designed, the ‘CleanTap’.

Street food vendor in India using the CleanTap. Photo courtesy Dimpy Dave

“I was inspired to design the CleanTap after I caught typhoid from eating street food in India,” laughed Seth. She found the key to motivating food vendors to acquire and use her product prototype was to prove it made good business sense, through creating customer demand for cleanliness. Her early results have been promising. And Cici Pandol from SoapBox Soaps described their innovative business model as the ‘TOMS of Soap’, donating a bar of soap to someone who needs it for every bar of soap they sell.

Innovation can also be undertaken by looking beyond the water, sanitation and hygiene sector for handwashing promotion. Given the wide and diverse benefits of good handwashing, a wide and diverse promotion strategy is needed around the world. We heard about integrating handwashing promotion with face washing to prevent trachoma, with menstrual hygiene management to empower girls to attend school and promote gender equality, and as part of a program to improve children’s nutrition in schools.

As Chris Williams, Executive Director, Water Supply & Sanitation Collaborative Council put it, “It’s one thing to get people to wash their hands; it’s another thing for them to still do it years later.” One approach to help make habits stick is being trialed by the SuperAmma campaign who are optimistic about the impact of changing handwashing messages from the old education messages – “protect yourself from germs” – to motivators that speak directly to people’s emotions, moving them from knowing they ought to wash their hands and doing it a few times, to actually doing it routinely, over and over again.

The motivators they have tried included presenting handwashing as a way for parents to nurture children and teach them good manners; persuading children that unwashed hands are disgusting, and helping everyone see that everyone else is doing it. It will be interesting to see the results.

On Global Handwashing Day these innovations are a timely examples of the inspiring things happening right now to breathe new life into an old public health challenge – the simple but incredibly effective act of washing your hands with soap.

Layla McCayLayla McCay is a medical doctor and global health specialist, with a special interest in global health technology and innovation. She has worked across health policy sectors, from the World Health Organization and the World Bank to International NGOs and the British Government. She teaches international health at Georgetown University. You can find her on Twitter @LaylaMcCay

Digital Diversity is produced by Ken Banks, innovator, mentor, anthropologist, National Geographic Emerging Explorer and Founder of, FrontlineSMS and Means of Exchange. He shares exciting stories in Digital Diversity about how mobile phones and appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives. You can follow him on Twitter @kiwanja

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Meet the Author
Ken Banks is an innovator, mentor, anthropologist and National Geographic Emerging Explorer. Founder of and now Head of Social Impact at Yoti, he spends his time applying Yoti's digital identity solutions to humanitarian problems around the world. His earlier research resulted in the development of FrontlineSMS, an award-winning text messaging-based field communication system designed to empower grassroots non-profit organisations. He shares exciting stories in "Digital Diversity" about how mobile phones and other appropriate technologies are being used around the world to improve, enrich, and empower billions of lives.