Reflections and learnings on hygiene within Water for Women

This 'Dive deeper' series give readers a chance to learn more from Water for Women's experience and should be read in conjunction with our more detailed Impact Report.

Progress

 Improving the rate of handwashing with soap has the greatest impact on health of all WASH activities and is highly cost effective. Rather than being the most prominent WASH activity in WfW, hygiene generally received less attention than sanitation and water supply. Nevertheless, during the Phase 1, WfW reported 1.4 million beneficiaries for hygiene, slightly exceeding its target. This was largely the result of 3 projects (Plan Indonesia, IRC Pakistan and WV Bangladesh) that incorporated handwashing promotion in their community-led total sanitation programming, resulting in very high numbers of beneficiaries in these countries. During the Extension Phase, there was less attention placed on hand hygiene and WfW only reached 26.7% of the target beneficiaries for hygiene (although Plan Indonesia still reached over 250,000 beneficiaries). The synthesis report of CSO project final evaluations noted that there was very modest progress in most projects and that rates for handwashing in Vanuatu, Nepal and Laos did not improve from those in Phase 1.

As discussed below, compared to sanitation and water supply, it is more difficult to link hygiene to climate risks and resilience. This is one likely reason for the lower levels of progress against hygiene targets.  Other factors included the brief duration of the Extension Phase, which precluded the development and implementation of new, climate resilience-focused hygiene behaviour change campaigns; systems strengthening activities that focused on improving water supply, including water safety planning, which often does not extend to hygiene; and a drop-off from the intense interest in hand hygiene during the COVID-19 pandemic.

Linking hygiene to climate resilience

The concept of climate-resilient water is easily understood and makes sense intuitively. For sanitation, the link to climate resilience has been less clear, but is emerging, particularly as studies demonstrate that poor sanitation systems contribute to greenhouse gas emissions. Efforts to reduce emissions through effective sanitation management is one link between sanitation and climate change, but links to the adaptation agenda and the contribution to climate resilience are also important. The Climate Resilient Sanitation Coalition was established to advocate for the visibility of sanitation within the climate action agenda. A key success of their work is the publishing of the Sanitation Annex for the Green Climate Fund.

The link between climate resilience and hygiene is more subtle. Hygiene is connected to personal and therefore community resilience (that is, health and wellbeing), so is a precursor for the climate resilience of communities.  Good hygiene, including handwashing, relies on access to water, which climate change affects. Indirectly, climate change might affect handwashing via impacts on water, but it makes little sense to explore climate-resilient hygiene if it simply refers to the climate resilience of water supplies. It is conceivable that in the face of water scarcity, water conservation measures (such as reuse of grey water) should be promoted, but these are to improve sustainability of water resources, not to promote good hygiene. Indeed, a strong focus on water conservation might inhibit use of water for hygiene in some settings. While several projects, including SNV Bhutan and WaterAid Timor-Leste, developed hygiene materials during the extension, WfW partners did not explore the link between climate resilience and hygiene directly. Reporting did not highlight approaches that strengthened the climate resilience of hygiene behaviour.  Interestingly, the health aspect of hand hygiene has not traditionally been a driver of behaviour change within communities, and WfW experience indicates that this continues to be the case.  

Menstrual health

There was sustained effort on menstrual health during the Extension Phase, despite a reduced focus being expected. Good menstrual hygiene relies on access to water and sanitation, so climate-resilient water and sanitation provides the basis for practising good MH. Those who menstruate will require access to climate-resilient water and sanitation services.  MH is critical in its own right and should not have to rely on climate resilience aspects to be a development priority, including for WASH programs. However, climate resilience can add more adaptive capacity and coping mechanisms for individuals who bleed to hygienically manage their periods in the changing conditions due to climate change, particularly with increasing water insecurity and droughts. Connections between menstrual health, community resilience and climate resilience are outlined in the Learning Brief (Menstrual Health: A Critical Cornerstone of Community and Climate Resilience - Water for Women Fund).