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Handwashing & Hygiene

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Handwashing programs in schools refer to organized initiatives designed to promote and establish regular and effective handwashing practices among students, staff, and the broader school community. These programs aim to improve hygiene, reduce the spread of infectious diseases, and create a healthy learning environment. Key components of handwashing programs in schools typically include:

• Education and Awareness: Providing information on the importance of handwashing for preventing the spread of illnesses and conducting educational sessions to teach proper handwashing techniques, including the use of soap and water.
• Infrastructure and Resources: Ensuring that schools have adequate facilities for handwashing, including sinks with running water, soap dispensers, and paper towels or hand dryers and regular maintenance of these facilities to ensure they are functioning properly.
• Integration into Curriculum: Incorporating hand hygiene education into the school curriculum, making it a part of health and science classes and reinforcing the importance of handwashing through various subjects and activities.
• Promotion of Good Habits: Encouraging regular handwashing at key times, such as before meals, after using the restroom, and after coughing or sneezing and providing reminders and signage in strategic locations to reinforce the habit.
• Involvement of Parents and Guardians: Engaging parents and guardians in the handwashing program, providing them with information and resources to promote hand hygiene at home and encouraging parents to reinforce handwashing habits and model good behavior.
• Monitoring and Evaluation: Regularly assessing the effectiveness of the handwashing program through surveys, observations, and feedback from students and staff and making adjustments to the program based on the results of evaluations.
• Community Outreach: Extending the handwashing program to involve the wider community, fostering a culture of hygiene beyond the school premises and collaborating with local health authorities and organizations to enhance the impact of the program.
• Emergency Preparedness: Incorporating hand hygiene practices into emergency preparedness plans, emphasizing the importance of cleanliness during disease outbreaks or other health emergencies.
• Celebrations and Events: Organizing events and campaigns to celebrate Global Handwashing Day or other relevant occasions, creating a sense of community around hygiene practices.
• Crisis Communication: Establishing clear communication channels to convey important information related to hand hygiene during health crises.

By implementing comprehensive handwashing programs, schools contribute to the overall well-being of students, staff, and the broader community, fostering a healthy and conducive learning environment.

This "Glossary Term presents a brief summary of this intervention,. Click on the ""Handbook Section" providing even more depth or prepare a  Bibliography/Toolbox that will have has a list of key research and resources. The tab on "Additional Resources" will provide links to webinars, projects, initiatives confer3nces and more.
This summary was first posted in October 2016. Currently it has been posted initially as  a draft prepared by AI (ChatGPT) With the participation of readers and partners we will proceed to prepare a "first draft", "revised drafts" and then  "first or revised editions".
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​Handwashing Programs in Schools                                                              Access a MS Word version of this summary
Classroom instruction, class and school activities, school routines, sinks and other facilities in schools, parent and community involvement that promote hand washing are an important part of more comprehensive programs related to water, sanitation and hygiene. Hygiene interventions can focus on hand washing behavior at key times (before eating and after using the toilet or latrine), safe excreta management, and consumption of clean water. Children receiving weekly handwashing promotion and soap had 50% fewer diarrheal and respiratory infections than those not receiving the intervention. Studies reveal that school-wide handwashing programs can make a difference in the health of students and staff and, as a result, improve school attendance.

The elements of a multi-intervention program in schools to promote hand-washing include skills-based hygiene education, school routines such as handwashing before meals, adequate and maintained hand-washing facilities, class and school-wide awareness activities, parental involvement and community support/engagement. The program should be developed within a systems-based strategy that encourages community and country ownership as well as an explicit plan for capacity-building and program sustainability/financing.

Education, Awareness and Routines to Promote Hygiene Habits
To have the greatest public health impact, the improvement of hygiene, sanitation, and water facilities in schools should go hand in hand with hygiene education programsand class/school routines that seek to change hygiene behaviors. To optimize public health impact, school hygiene, sanitation, and water projects should adhere to two basic principles:

• Encourage user involvement in sanitation through hygiene promotion
  • Include a range of technologies and service levels for water supply, sanitation, and hand washing facilities
  • Coordinate interventions with national health programs and ensure that interventions supplement such national programs
• Make a hygiene habits values hygiene education program the centerpiece of each hygiene, sanitation, and water in schools project.
  • Establish clear objectives, performance indicators, and monitoring and evaluation processes
  • Focus on changing a small set of key risk practices
  • Build on existing beliefs and community practices, and seek effective and sustained use of water supply, sanitation, and hand washing facilities and hygiene practices
  • Adopt a child-centered approach that takes into account the ways children learn and their everyday reality as well as the fact that classes in many developing schools include children of different ages and so require the use of flexible hygiene education methods
  • Focus on developing skills and attitudes, because knowledge does not automatically translate into practice
  • Plan on implementing hygiene education over the long term, rather than as a one-off program, to ensure that knowledge is translated into the use of (new) hygiene practices. Ensure that the classroom instruction is accompanied by school routines such as washing hands before school meals and various class, school or community awareness activities.

Hand Washing Facilities in Schools
Unfortunately, most schools in developing countries do not provide appropriate hand washing facilities. Where these facilities are available, they may be poorly located, have insufficient hand washing materials, be inaccessible, or be improperly used.

• Location: For older children the hand washing facility should be located near the place where children defecate. For younger children, teachers may prefer to have the facilities located in or near the classroom so that they can supervise hand washing.
• Materials: Hand washing facilities may lack soap, ash, mud, or other hand washing agents and hygienic materials for drying hands after washing. Sometimes this is because the materials are not available and/or the school does not have the money to pay for them. In addition, hand washing materials such as soaps are frequently stolen, especially when the facilities are located away from the school building close to the toilets at places with little or no supervision.
• Access: Hand washing facilities may be inaccessible because they are locked for fear of theft. They may also be available but not usable due to a lack of water.
• Use: In practice, many hand washing facilities are also used for drinking water. If feasible, the facilities should provide safe drinking water. If this is not possible, children, teachers, and other school staff should be made aware that the water is not safe for consumption and that safe drinking water is provided at another location in the school or schoolyard. Also, attention should be given to water wastage, focusing on the closure of taps after use and the avoidance of unnecessary emptying of water basins and containers.

Community & Stakeholder Participation:
Participation of all stakeholders is required to ensure that gender and poverty issues are addressed and to ensure access to sustainable facilities. To foster representative and informed participation by all stakeholders, school hygiene, sanitation, and water projects should adhere to the following principles:

• Ensure stakeholder participation in decision-making and management through appropriate project rules, incentives, and social intermediation.
• Ensure representative and informed participation by all stakeholders, especially girls and women, to ensure that specific gender-based needs are taken into account.
• Set rules to ensure that target schools located in poorer, more isolated communities can be reached
• Set rules to ensure that vulnerable groups such as children with disabilities and children from minority groups will benefit from hygiene, sanitation and water in schools project interventions.
• Facilitate stakeholder participation in program design and evaluation.
• Include representatives of all stakeholder groups in monitoring and evaluation.

Capacity-Building
Define capacity-building components clearly in order to enable all stakeholders to assume their responsibilities in hand-washing programs and other WASH approaches.

• Target training to schools (teachers, students, and parents), communities, the private sector and NGOs, and different levels of government
• Use a learning-by-doing approach
• Provide outreach, intermediation, and training before, during, and after the construction of facilities
• Provide training that is time bound and impact oriented, with performance monitoring and targets to measure capacity building
• Develop opportunities for stakeholders to participate and build capacity

Financing Options
Service expansion has been constrained by insufficient resource allocation and inefficient investments in hygiene promotion programs. Similarly, operation and maintenance (O&M) of existing facilities is hampered by lack of capacity to mobilize resources from users, lack of O&M plans, and insufficient O&M training.To ensure long-term financial sustainability, school hygiene, sanitation, and water projects should adhere to two basic guidelines:

• Establish a financial policy which ensures that operation and maintenance can be carried out in a sustainable manner.
  • Prepare O&M plans that clearly define responsibilities and monitoring procedures
  • Prepare O&M plans that are focused on preventive maintenance, with lists of tasks as well as detailed task schedules
• Establish financial policies that are sustainable, preferably ones in which O&M costs are covered by the education budget.
  • Ensure that, at a minimum, O&M costs are covered
  • Obtain parent and school consensus if they must pay part or all of the investment costs associated with higher service levels
  • Ensure that subsidies for the cost of facilities are transparent and well targeted
  • Provide detailed information on the cost of facilities
  • Ensure that the government pays for facilities and O&M through the school budget and takes responsibility for the delivery of hygiene promotion, capacity building, and training
  • If the government is unable to pay for routine O&M, design user fee structures (either in-kind or in cash) in such a way that they do not hamper the ability of the poor to send their children to school

Sources and References

• FRESH Partnership (2014) Thematic Indicator 1: Water, Sanitation and Hygiene, Monitoring and Evaluation Guidance for School Health Programs: Thematic Indicators, p.7, Paris, UNESCO
• Adams, J., Bartram, J., Chartier, Y. and Sims, J. (2009) Water, sanitation and hygiene standards for schools in low-cost settings, Geneva, World Health Organization
• UNICEF. (2011) WASH in schools, New York, UNICEF.
• World Bank (2005) Toolkit on Hygiene, Sanitation & Water in Schools, Washington, DC, Author
• GIZ (nd) ‘The Fit for School – Effective school health programme’, Manila, GIZ
  The Fit for School approach focuses on effective school health programmes that can be financed locally and implemented using the resources of the education sector. Thanks to high school enrolment rates, health programmes in primary schools reach the majority of school children regardless of their socio-economic background. Daily teeth brushing with fluoride toothpaste and hand washing with soap are integrated into the children’s normal school day in the form of group activities. The children are also dewormed twice each year. These daily routines have a lasting effect on hygiene practices and supplement traditional forms of health education, which are based on knowledge transfer only. The programme also involves improving water supplies and sanitary services, in particular through the installation of hand washing stations. Improving access to water and providing sanitary facilities suitable for children in the participating schools create a healthy school environment which is essential for improving long-term health. The programme’s success is mainly attributable to the following factors:
  - Simplicity. Implementing measures that are aimed at combating the most common illnesses and that can be carried out by the teaching staff at low cost.
  - Scalability. Developing realistic implementation models and using existing structures in the education sector in order to implement the programme nationwide.
  - Sustainability. Securing funding from local or national governments in order to ensure the programme’s sustainability; actively involving parents and local communities in order to strengthen ownership and transparency.
• M. Sidibe and V. Curtis, (2013) Can hygiene be cool and fun? Insights from school children in Senegal, Nairobi: World Bank Water and Sanitation Program 
  This field note summarizes formative research that looked at motivating factors underlying the behavior of Senegalese primary school children. Specifically, the research looked at what motivates children in this age group to adopt hygienic hand-washing.
• GIZ, UNICEF (2013) Three Star Approach for WASH in School: Simple, Scalable, Sustainable, New York, UNICEF 
  In the Three Star Approach, schools are encouraged to take simple, inexpensive steps outlined in this Field Guide. These steps are designed to ensure that all students wash their hands with soap, have access to drinking water, and are provided with clean, gender-segregated toilets at school every day. The Three Star Approach involves changing the way WASH in Schools programming is perceived by schools, communities, and decision makers in government and support agencies. By prioritizing the most essential actions for achieving goals, the Three Star Approach helps schools focus on meeting children’s needs through key interventions. At the same time, it provides a clear pathway for all schools throughout a country to meet national standards, and for all children to have hygiene-promoting and healthy schools. It encourages local action and support from communities and does not depend on expensive hardware inputs from the education system or external support agencies.
• IRC (2007) Towards Effective Programming for WASH in Schools: A manual on scaling up programmes for water, sanitation and hygiene in schools. Delft, The Netherlands, IRC International Water and Sanitation Centre.
  This manual deals with school water, sanitation and hygiene education. It describes many of the elements needed for scaling up programmes for water, sanitation and hygiene in schools while ensuring quality and sustainability. The manual is meant for government, UNICEF and other (I)NGO staff responsible for programming WASH in Schools
• Matthew Freeman, Sarah Fry, Bella Monse, Dan Abbott, Sarah Bramley, Seung Lee, Therese Dooley, Tiya Habachy, Greg Keast, Catherine Rutgers, Murat Sahin, Yodit Sheido and Peter van Maanen, Elynn Walter, Louisa Gosling, Shamila Jansz, Thérèse Mahon, Yael Velleman, Jane Wilbur, Lotika Paintal, Mark Duey and Erin Wright, Hazel Jones, (2012) Raising Even More Clean Hands: Advancing Health, Learning and Equity through WASH in Schools, Joint Call to Action, New York, UNICEF 
  This Call to Action for WASH in Schools supports global efforts and a common vision: a world where all children go to school and all schools provide a safe, healthy and comfortable environment where children grow, learn and thrive. Because every child has the right to be in a school that provides safe water, sanitation and hygiene education, we call for renewed commitments to: 1. Set minimum standards for WASH in Schools. 2. Monitor WASH in Schools coverage through Education Management Information Systems (EMIS). 3. Engage with at scale WASH in Schools programmes. 4. Involve multiple stakeholders to support WASH in Schools programmes. 5. Contribute evidence on the impact of WASH in Schools programmes. 6. Raise the profile of WASH in Schools programmes. More than 60 organizations have joined together to renew their commitments and create a more cohesive group to support and advocate for WASH in Schools. We call on decision makers and concerned stakeholders to join in this collaborative effort and support WASH in Schools – so that all children have the opportunity to go to a school with access to safe water, child-friendly sanitation facilities and hygiene education.
• Hutton G, Chase C (2016) The Knowledge Base for Achieving the Sustainable Development Goal Targets on Water Supply, Sanitation and Hygiene, Int J Environ Res Public Health. 2016 May 27;13(6). pii: E536. doi: 10.3390/ijerph13060536.
• Willmott M, Nicholson A, Busse H, MacArthur GJ, Brookes S, & Campbell R. (2015). Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: A systematic review and meta-analysis. Archives of Disease in Childhood. 2016 Jan;101(1):42-50. doi: 10.1136/archdischild-2015-308875. Epub 2015 Oct 15
• Warren-Gash C, Fragaszy E, Hayward AC. (2013) Hand hygiene to reduce community transmission of influenza and acute respiratory tract infection: a systematic review. Influenza Other Respir Viruses. 2013 Sep;7(5):738-49. doi: 10.1111/irv.12015. Epub 2012 Oct 8. Review.
• Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA.(2015) Hand washing promotion for preventing diarrhoea. Cochrane Database Syst Rev. 2015 Sep 3;9:CD004265. doi: 10.1002/14651858.CD004265.pub3. Review.
• Taylor DL, Kahawita TM, Cairncross S, & Ensink JH. (2015). The impact of water, sanitation and hygiene interventions to control cholera: A systematic review. PLoS ONE, 10(8), e0135676 (Full text)
• Trinies V, Garn JV, Chang HH, Freeman MC (2016) The Impact of a School-Based Water, Sanitation, and Hygiene Program on Absenteeism, Diarrhea, and Respiratory Infection: A Matched-Control Trial in Mali. Am J Trop Med Hyg. 2016 Jun 1;94(6):1418-25. doi: 10.4269/ajtmh.15-0757. Epub 2016 Apr 25
• Wong VW, Cowling BJ, & Aiello AE. (2014) Hand hygiene and risk of influenza virus infections in the community: A systematic review and meta-analysis, Epidemiology & Infection, 142(5), 922-932
• Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP. (2013) The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health. 2013 Oct 26;13:1015. doi: 10.1186/1471-2458-13-1015. Review
• Curtis, C. and S. Cairncross (2003). “Effect of Washing Hands with Soap on Diarrhoea Risk in the Community: A Systematic Review”, The Lancet Infectious Diseases 3 (5), 275–281
• M. Freeman et al. (2013), ‘The Impact of a School-Based Hygiene, Water Quality and Sanitation Intervention on Soil-Transmitted Helminth Reinfection: A Cluster-Randomized Trial.’ Am J Trop Med Hyg., vol. 89, no. 5, November 2013, pp. 875-83.
• M.K. Patel et al.(2012), ‘Impact of a Hygiene Curriculum and the Installation of Simple Handwashing and Drinking Water Stations in Rural Kenyan Primary Schools on Student Health and Hygiene Practices.’ Am J Trop Med Hyg., vol. 87, no. 4, 2012, pp. 594–601.
• C. Lopez-Quintero, P. Freeman and Y. Neumark (2009). ‘Hand Washing Among School Children in Bogotá, Colombia.’ Am J Public Health, vol. 99 no 1, 2009, pp. 94-101.
• Talaat et al. (2011), ‘Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt.’ Emerg Infect Dis., vol. 17, 2011, pp. 619–625.
• A. Bowen et al (2007) ‘A Cluster-Randomized Controlled Trial Evaluating the Effect of a Handwashing-Promotion Program in Chinese Primary Schools.’ Am J Trop Med Hyg., vol. 76, 2007, pp. 1166-1173.
• L. Greene et al. (2012) ‘Impact of a school-based hygiene promotion and sanitation intervention on pupil hand contamination in Western Kenya: a cluster randomized trial.’ American Journal of Tropical Medicine and Hygiene, vol. 87, 2012, pp. 385-393
• Blanton et al. (2010) ‘Evaluation of the role of school children in the promotion of point-of-use water treatment and handwashing in schools and households - Nyanza province, Western Kenya.’ Am. J. Trop. Med. Hyg.,vol. 82, 2010, pp. 664–671.
• C.E. O’Reilly et al., ‘The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya.’ Epidemiology and Infection. vol. 136, 2008, pp. 80-91.
• M. Freeman et al. (2012) ‘Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster randomized trial.’ Trop Med Int Health. vol. 17, no. 3, 2012, pp. 380-391.
• A.R. Dongre et al (2007), ‘An approach to hygiene education among rural Indian school going children’, Online Journal of Health and Allied Sciences, vol. 6 no. 4, 2007.
• Curtis, V. et al.(2001), ‘Evidence of behaviour change following a hygiene promotion programme in Burkina Faso‘, Bulletin of the World Health Organization, vol. 79, no. 6, 2001, pp. 518-527
• C.R. Chittleborough et al.(2012) ‘Factors influencing hand washing behavior in primary schools: process evaluation within a randomized controlled trial’, Health Educ Res., vol. 27, no. 6, December 2012, pp. 1055-68.
• T.T Xuan et al., ‘Teaching handwashing with soap for schoolchildren in a multi-ethnic population in northern rural Vietnam’, Glob Health Action, vol. 6, no. 24, April 2013, pp. 1-12
• K. Mathew et al., (2009) ‘The sustainability and impact of school sanitation, water and hygiene education in southern India’, Waterlines. 2009, 28.
• S. Saboori et al., (2011) ‘Sustaining school hand washing and water treatment programmes: lessons learned and to be learned’, Waterlines, vol. 30, no. 4, 2011, pp. 298-311.
• S. Saboori, A. Mwaki and R.D. Rheingans, (2010) ‘Is soapy water a viable solution for handwashing in schools?’, Waterlines, vol. 29, no. 4, 2010, pp. 329-336
• Christian Jasper, Thanh-Tam Le, and Jamie Bartram (2012) Water and Sanitation in Schools: A Systematic Review of the Health and Educational Outcomes, Int J Environ Res Public Health. 2012 Aug; 9(8): 2772–2787.
• Joshi A, Amadi C (2013) Impact of water, sanitation, and hygiene interventions on improving health outcomes among school children, J Environ Public Health. 2013;2013:984626. doi: 10.1155/2013/984626. Epub 2013 Dec 28.
• Freeman MC, Ogden S, Jacobson J, Abbott D, Addiss DG, Amnie AG, Beckwith C, Cairncross S, Callejas R, Colford JM Jr, Emerson PM, Fenwick A, Fishman R, Gallo K, Grimes J, Karapetyan G, Keene B, Lammie PJ, Macarthur C, Lochery P, Petach H, Platt J, Prabasi S, Rosenboom JW, Roy S, Saywell D, Schechtman L, Tantri A, Velleman Y, Utzinger J. (2013) Integration of water, sanitation, and hygiene for the prevention and control of neglected tropical diseases: a rationale for inter-sectoral collaboration, PLoS Negl Trop Dis. 2013 Sep 26;7(9):e2439. doi: 10.1371/journal.pntd.0002439. eCollection 2013
• Curtis VA, Danquah LO, Aunger RV (2009) Planned, motivated and habitual hygiene behaviour: an eleven country review, Health Educ Res. 2009 Aug;24(4):655-73. doi: 10.1093/her/cyp002. Epub 2009 Mar 13
• Phillips RM, Vujcic J, Boscoe A, Handzel T, Aninyasi M, Cookson ST, Blanton C, S Blum L, Ram PK (2015) Soap is not enough: handwashing practices and knowledge in refugee camps, Maban County, South Sudan, Confl Health. 2015 Dec 20;9:39. doi: 10.1186/s13031-015-0065-2. eCollection 2015

This tab displays a selection of key research and resources related to hand-washing programs in schools. Please access this more extensive bibliography/tool box published as a MS Word Document.
​
Key Research & Resources on School Handwashing programs . 

Research Reviews

Reports

Planning Resources

Please note that we use this extensive outline for these lists of research and resources. This outline for our bibliography/toolboxes includes these sections:
A. Understanding the Problem: (Nature of the problem, burden/benefits, prevalence, nature, aspects, social
influences, social determinants, influence of the school, behaviour theories, key insights that explain it)

B. Impact, Role of the School on the Problem (Influence of the physical and social environment, school
organization & practices)

C. Effects of Individual Evidence-based and Experience-tested Interventions (Including Policy, Instruction,
Services, Social Support, Physical Environment Interventions)
​
D. Effects of Multi-Intervention Approaches, Programs, Strategies including Comprehensive Approaches
(Multi-issue, multi-level, multi-system programs) Coordinated Programs and Services (School-Agency
Programs and Whole School Only Strategies)
E. Implementation, Maintenance, Scale Up and Sustainability (Including Evidenced-based, Practical and
Strategic Implementation Strategies, diffusion or education change theories,

F. Capacity and Capacity-building (Baseline human, financial, time resources as well as aspects of
system/organizational capacity including coordinated policy across sectors, leadership, assigned
coordinators, workforce development, monitoring/reporting, issue management and others)

G. Consideration of Local Community Contexts (Including rural, cultural, disadvantaged, faith etc.)

H. Consideration of and Integration within the Constraints and Educational Mandate of the School

I. Consideration of Concepts &amp; Tools from Systems Science and Organizational Development (Including
consideration of system, organizational characteristics)
​
J. Questions related to Future and Current Research (Methods, link to educational outcomes, cost-
effectiveness etc.)
​

For updates and reader comments on this section, go to our Mini-Blog on Low Resource Countries
(The number of summaries completed or drafted in this section are listed below)

- Low Resource Countries-Introduction
- Multi-Component Approaches (MCAs) in LRCs

• School Health & Nutrition
• The Essential Package of Interventions

- Multi-Intervention Programs (MIP) in LRCs

• Equitable Access to Education
  - Out of School Strategies
  - Learning Disabilities
  - Girls Education
  - Displaced/Stateless Students
  - Financial Incentives to Attend School
• WASH Programs (Overview)
  - Clean Water
  - Sanitation
  - Handwashing & Hygiene
  - Feminine Hygiene
  - Oral/Dental Health
• School Food & Nutrition
  - School Meals/Feeding
  - Home Grown School Feeding
  - Nutrition Supplements
  - Healthy Diet/Eating
  
• Preventing Infectious Diseases
  - Malaria
  - Tuberculosis
  - Dengue Fever
• Preventing Non-Communicable Diseases (Overview)
  -  Healthy Eating
  - Tobacco & Alcohol Use
  - Physical Activity
• Psycho-social Support
  - Mental Health
  - Social & Emotional Learning
• Growth & Development
  - Stunting
  - Vision
  - Hearing

• Youth Engagement in LRCs
• Parent Participation in LRCs
• School-Linked Community Development in LRCs