Clean hands are within reach

Hands4health partners join hundreds of millions of people around the world in celebrating Global Handwashing Day on the 15th of October – a worldwide awareness day dedicated to raising the importance of handwashing with soap.

Good handwashing can prevent disease outbreaks, reduce school absences, and improve healthcare outcomes. Despite these benefits, handwashing with soap is practiced too rarely, and the results are tragic. Every year, 1.4 million children die from diarrhea or pneumonia. Infections cause 15% of newborn deaths. Diarrhea alone leads to millions of lost school days every year. Handwashing with soap is an effective way to prevent these losses.

Although progress has been made, hand hygiene efforts need to be tripled to reach global targets, with only one in seven countries on track to achieve universal basic access to hygiene by 2030. Data from the 2022 Joint Monitoring Programme highlights that 2 billion people worldwide still lack access to basic hygiene services, including 653 million people without any handwashing facility at all.

The theme of this year’s Global Handwashing Day “Clean hands are within reach” explores a systemic approach to hand hygiene. This requires not only a focus on individual hand hygiene behaviour, but also a broader effort to create an enabling environment that supports the scaling up of hand hygiene within specific contexts.

This resonates strongly with the approach of the hands4health project. In Nigeria, Palestine, Burkina Faso and Mali, we are developing and implementing a comprehensive approach to hand hygiene, water quality and sanitation in primary health care facilities and schools not connected to functional water supply systems. To investigate the intervention’s overall effect, a health impact evaluation is being conducted through cluster randomised controlled trials.

Project updates

Below, we would like to share some of the handwashing-related activities from the hands4health project countries. You can find out more about the project through the latest updates on our website and by registering for our newsletter.

Palestine, West Bank

The Cesvi and Palestine Polytechnic University (PPU) teams have been working on the water, sanitation and hygiene (WASH) rehabilitation works in 18 schools in Palestine, which included: 

  • Installation / rehabilitation of handwashing stations to make it easier for the students to handwash.  
  • Water saving taps in the handwashing stations to conserve water in face of the water shortages.
  • Installation of water tanks that are connected to handwashing stations.
  • Installation of soap dispensers in 13 schools, including the provision of liquid soap. 
  • Implementation of RANAS behaviour change activities in 14 schools (3 activities per school). 
  • Water quality monitoring, including the distribution of free chlorine measuring devices to 22 schools, so that the free chlorine concentration can be measured on a weekly basis. 

The project team is closely monitoring the evolvement of the security situation in the project area and will resume activities whenever feasible.        


The Global Handwashing Day 2023 campaign enforces that: “Through strong leadership and collective efforts, we can close gaps in access and practice to achieve hand hygiene for all. Everyone has a role to play to ensure clean hands are within reach.”

The Terre des hommes (Tdh) team in Nigeria is committed to doing its part. The team will organise a Global Handwashing Day campaign in 13 public primary schools part of the hands4health intervention within the Maiduguri Metropolitan Council and Jere local government areas in Borno State. School children will be sensitised on appropriate handwashing practices at critical times and engaged into a behavior change activity called “Walls of Handwashing”.

The goal is to: (i) Create awareness, so that every child knows the importance of handwashing and acts upon it at critical moments; (ii) Change the children’s behaviour, so they use soap when handwashing; and (iii) Educate teachers and students on proper handwashing behaviour, so they make handwashing at school a habit. By providing effective information about the positive effects of handwashing habits, the team hopes to foster a change of behaviour towards increased handwashing at critical times.

©Tdh – Wall of handwashing activity part of the RANAS behaviour change campaigns that took place earlier in the project.

Mali and Burkina Faso

Hands4health is proud to directly contribute to improving hand hygiene in primary health care centres not connected to functional water supply systems in Mali and Burkina Faso. The comprehensive approach to hand hygiene, water quality and sanitation (WASH) being implemented in these countries is structured around improvement of hardware, management and monitoring of WASH services, and behaviour change.

The lack of water, sanitation and hygiene in health care facilities was observed directly by the hands4health team. In Mali, 12% of health care facilities in a sample assessed by the project team did not have access to safe water, and only 10% had access to handwashing facilities.

In both Mali and Burkina Faso, the project teams observed an important gap between stated handwashing behaviour and the reality:

  • In Mali, while more than 80% of the sampled healthcare staff reported washing their hands with soap or sanitiser during a WHO key moment, fewer than 10% did so in reality.
  • In Burkina Faso, fewer than a sixth of healthcare staff did so.

This highlights the importance to address hand hygiene through the enabling environment as well as through the improvement in WASH services and behaviour change.  In Mali and Burkina Faso, the hands4health project is deploying innovative Gravit’eau handwashing stations in primary healthcare centres, along with improvements to the management and monitoring of WASH services through the WASH FIT approach and behaviour change activities.


The Laboratory for Water Quality and Treatment (LTQE), at the Swiss Federal Institute of Technology in Lausanne (EPFL), has been leading the research on the efficiency of chlorine disinfection in the presence of surfactants and hand soap.

The key findings indicate that the presence of surfactants (e.g., cocamidopropyl betaine, the main ingredient in hand soap) enhance chlorine disinfection efficiency. The LTQE team also observed that when B. subtilis spores (surrogate microorganisms) were pre-exposed to surfactants or in hand soap for hours, the disinfection efficiency of the chlorination that followed was significantly enhanced.

These findings provide important insights for the hands4health project implementation. For the Gravit’eau handwashing station, chlorine should be applied early in the morning, to take advantage of the synergistic effect resulting from the pre-exposure to hand soap during the night.

LTQE’s team has been actively supporting the dissemination of hands4health research results to a wider audience. The research findings of the first part of the project were published as an open-access research article in the journal of Water Research. During the EPFL Open Days (29 – 30 April, 2023), the Gravit’eau handwashing station was introduced to hundreds of people in Switzerland.

Urs von Gunten and Tianqi Zhang also attended the Water Disinfection, Byproducts and Health Gordon Research Conference in South Hadley, USA, in August 2023. In the conference, Tianqi gave a poster presentation entitled Chlorination of amides: Kinetics and mechanisms of formation of N-chloramides and their reactions with phenolic compounds.

©EPFL-LTQE – Urs von Gunten and Tianqi Zhang at the Water Disinfection, Byproducts and Health Gordon Research Conference in South Hadley, USA, in August 2023.

More information and resources

If you would like to find out more about Global Handwashing Day and to raise awareness of this essential gesture, we recommend the official website, available in English French and Spanish.

Useful resources include: