Costs of hand hygiene for all in household settings: estimating the price tag for the 46 least developed countries

Abstract

IntroductionDomestic hand hygiene could prevent over 500 000 attributable deaths per year, but 6 in 10 people in least developed countries (LDCs) do not have a handwashing facility (HWF) with soap and water available at home. We estimated the economic costs of universal access to basic hand hygiene services in household settings in 46 LDCs.MethodsOur model combines quantities of households with no HWF and prices of promotion campaigns, HWFs, soap and water. For quantities, we used estimates from the WHO/UNICEF Joint Monitoring Programme. For prices, we collated data from recent impact evaluations and electronic searches. Accounting for inflation and purchasing power, we calculated costs over 2021–2030, and estimated total cost probabilistically using Monte Carlo simulation.ResultsAn estimated US$12.2–US$15.3 billion over 10 years is needed for universal hand hygiene in household settings in 46 LDCs. The average annual cost of hand hygiene promotion is US$334 million (24% of annual total), with a further US$233 million for ‘top-up’ promotion (17%). Together, these promotion costs represent US$0.47 annually per head of LDC population. The annual cost of HWFs, a purpose-built drum with tap and stand, is US$174 million (13%). The annual cost of soap is US$497 million (36%) and water US$127 million (9%).ConclusionThe annual cost of behavioural change promotion to those with no HWF represents 4.7% of median government health expenditure in LDCs, and 1% of their annual aid receipts. These costs could be covered by mobilising resources from across government and partners, and could be reduced by harnessing economies of scale and integrating hand hygiene with other behavioural change campaigns where appropriate. Innovation is required to make soap more affordable and available for the poorest households.

Current international tools and guidance for the implementation of hand hygiene recommendations in community settings: a scoping review

“…Documents were included if they met all of the following criteria: (1) international tool or guidance document, (2) is relevant to one of the six implementation steps in the conceptual framework, (3) targets at least one community setting, as defined in the conceptual framework, (4) published by an international non-governmental organisation (NGO), multilateral agency or public health agency, (5) published in English, and (6) published between 1 January 1990 and 1 August 2023.…”

“…Hand hygiene, which includes handwashing with soap and the use of alcohol-based hand rub (ABHR), is an important public health measure for the control and prevention of infectious diseases (1–3). Handwashing with soap has been found to be a cost-effective intervention that can reduce the risk of both diarrhoeal disease and acute respiratory infections by over 20% (4–7). Despite the international recognition of hand hygiene as a critical public health measure, there continues to be insufficient access to products and basic services in community settings, particularly in low- and middle-income countries (8–10).…”

“…While clear and robust recommendations developed by the World Health Organization (WHO) exist for hand hygiene in health care settings, there are gaps in global normative guidance on hand hygiene in settings where health care is not routinely delivered (12). A recent scoping review of current international guidelines for hand hygiene in community settings – categorised as non-healthcare settings – highlighted a lack of consistent and evidence-based recommendations across four key areas: (1) what constitutes effective hand hygiene, (2) minimum requirements for practicing hand hygiene, (3) effective behaviour change approaches to sustain hand hygiene, and (4) the role of government (12). As part of its mandate to address demand for guidance on public health topics where there is uncertainty and demand from governments, WHO is developing Guidelines for hand hygiene in community settings, with a series of systematic reviews underway to inform this effort (13).…”

Improving Waste Management and Public Health Using the Participatory Model in Delta State, Nigeria

“…In the year 2015, the lack of access to sanitation was estimated to have cost the global economy about 222.9 billion US Dollars, indicating a 22% rise from 182.5 billion US Dollars in 2010, with Africa accounting for approximately 10% of the global cost 17 . According to the Water and Sanitation Programme (WSP) administered by the World Bank, Nigeria loses over 3 billion US Dollars annually due to poor sanitation 18 . Also, the costs of poor sanitation are unevenly distributed with the highest economic burden falling inequitably on the poorest, as they are more likely to have poor sanitation and have to pay proportionately more for the negative effects.…”

Unsafe water, sanitation and hygiene: a persistent health burden

“…For example, the world’s 46 least-developed countries could have universal handwashing facilities by 2030 if governments invested less than 1 United States dollar per person per year in hand hygiene. 8 …”