Hygiene has long-established links with public health, but the COVID-19 pandemic thrust the issue of hand hygiene into prominence like never before. On Global Handwashing Day 2021, UNICEF and WHO launched ‘State of the World’s Hand Hygiene: a global call to action to make hand hygiene a priority in policy and practice’. The report argues that accelerating progress towards “adequate and equitable hygiene for all” as called for in SDG target 6.2 is a no-regrets investment that leaves the world better prepared to manage future disease outbreaks and pandemics.
Of the range of hygiene behaviours considered important for health, hand washing with soap is a top priority in all settings. The simple act of cleaning hands can save lives and reduce illness by helping prevent the spread of infectious diseases. These diseases can be caused by pathogens (germs) transmitted through the air or via surfaces, food or human faeces. Because people frequently touch their face, food and surfaces, hands play a significant role in spreading disease. It is estimated that half a million people die each year from diarrhoea or acute respiratory infections that could have been prevented with good hand hygiene. As well as preventing a multitude of diseases, hand hygiene can help avoid significant financial costs resulting from sickness and death.
Monitoring handwashing behaviour is difficult but the presence of soap and water at a designated place has been shown to be a robust proxy indicator. Household surveys increasingly include a handwashing module that involves direct observation of handwashing facilities. Data on drinking water and sanitation services have been routinely collected for many years, but collecting data on handwashing has only recently become standardized. Accordingly, while drinking water and sanitation estimates can be produced from 2000 through 2020, hygiene trends in this report are reported only from 2015 through 2020.
Since 2015 the population with access to basic hygiene services has increased by over 500 million, from 5.0 billion (67 per cent) to 5.5 billion (71 per cent), at a rate of 300,000 people per day. However, 2.3 billion people still lacked basic services in 2020, including 670 million people with no handwashing facilities at all. The data also reveal the gap in basic hygiene coverage between urban and rural areas: in 16 countries, the gap was more than 20 per cent pts and in 12 countries, the gap between highest and lowest subnational region was more than 50 per cent pts.
Data
Water and sanitation coverage
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Notes on the data
WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene
Since 1990, WHO and UNICEF have tracked progress on global water and sanitation goals through the Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP). The JMP monitors trends in coverage; helps build national monitoring capacity in developing countries; develops and harmonises questionnaires, indicators and definitions to ensure comparability of data over time and among countries; and informs policymakers of the status of the water supply and sanitation sector through annual publications. The JMP draws guidance from a technical advisory group of leading experts in water supply, sanitation and hygiene, and from institutions involved in data collection and sector monitoring. Further information about the JMP and its methodology can be found at the JMP website.
Data sources
The JMP estimates for WASH in schools are based on information collected through national Education Management Information Systems (EMIS), censuses and surveys, as well as secondary sources (e.g. UNESCO UIS) in the absence of primary data. Data are harmonized to the extent possible based on the indicator definitions for ‘basic’ service. Further details on indicators, data sources and methods for WASH in schools estimates can be found at the JMP website, including recommended core questions to support harmonized monitoring: Core questions and indicators for monitoring WASH in schools in the SDGs.
Definitions of basic WASH services in schools
Schools with an improved drinking water source with water available at the time of the questionnaire or survey are classified as having ‘basic’ service. Schools without water available, but with an improved source are classified as having ‘limited’ service, and those with unimproved or no water source are classified as having ‘no service’.
Schools with improved sanitation facilities which are single-sex and usable at the time of the survey or questionnaire are classified as having ‘basic’ service. The term ‘usable’ refers to toilets or latrines that are accessible to students (doors are unlocked or a key is available at all times), functional (the toilet is not broken, the toilet hole is not blocked, and water is available for flush/pour-flush toilets), and private (there are closable doors that lock from the inside and no large gaps in the structure). Those using improved sanitation facilities which are either not single-sex or not usable are classified as having ‘limited’ service. However, pre-primary schools without single-sex toilets may still be considered to have ‘basic’ sanitation service if the toilets are usable. Schools with unimproved or no toilets are classified as having ‘no service’.
Schools with handwashing facilities with water and soap available at the time of the questionnaire or survey are considered to have ‘basic’ service. Those with handwashing facilities that have water available at the time of the questionnaire or survey, but no soap, are considered to have ‘limited’ service, while schools with no facilities or no water available for handwashing are classified as having ‘no service’.