Bottleneck analysis of hand hygiene programming

A focus on technical and operational issues preventing scale-up in rural areas of India

Children from Lalmatia slum wash their hands during the Hand Wash Program


Hand hygiene, particularly, handwashing with soap, is recognized as a highly cost-effective public health intervention, which has the potential to reduce disease burden globally significantly. Handwashing with soap at five critical times- after defecation, after handling a child’s faeces, before feeding infants/children, before eating and before food preparation is estimated to reduce diarrheal diseases by 47 per cent and respiratory infections by 23 per cent, thereby meaningfully contributing to reductions in infant and child mortality. After the onset of the COVID-19 pandemic, hand hygiene has become a critical need of the hour to save human lives.  

Improving handwashing practices greatly depend on the availability of an adequate supply of water. Having said that, only 54.2 per cent of households in India have a Functional Household Tap Connection (FHTC) as of October 2022. Most of the available data on handwashing in India shows that critical data gaps in the sector limit consistent programming supporting hand hygiene. 

Given the context, this study was envisaged to assess the status of hand hygiene practice in rural India and undertake a bottleneck analysis of the enabling environment (policies and strategies, institutional arrangements, programmes, capacities) that hinders the upscaling of hand hygiene (HH) practice, and provide recommendations to improve the policies, strategies, and operational approaches of key stakeholders comprising of the technical and operational duty bearers.

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