Häusliche Händehygiene in Entwicklungsländern
A man uses a home handwashing facility in Burundi in 2012. Photo taken by Martina Winker.

What would universal handwashing cost?

We know that handwashing can be the most cost-effective measure in preventing infections. And while there are many studies on hand hygiene in the context of healthcare, there is a great need for a better understanding of hand hygiene at home. An estimated 500,000 a year are the result of lack of access to handwashing facilities at home.[1] A majority of people in what the researchers label as the least developed countries (LDCs) lack such access.[2]

As both the pandemic and a push for true universal healthcare continues around the world, it is worth asking: how much would it cost for to be able to safely and consistently wash their hands at home in 46 LDCs?

This study represents the “most detailed to date of the costs of hand hygiene in domestic settings.” The results—void of context—seem like a staggering number. To provide basic hand hygiene in household settings would cost US$ 12.2 – 15.3 billion over 10 years.[3] Placed within the context, though, it is a mere 1% of the aid that these 46 countries receive.[4] The dream of planetary-wide hand hygiene has an estimated price tag equivalent to that of, say, an ambitious new canal or hydro dam. Or half of what is being spent on the world’s largest airport.

What would it take to provide this?

The researchers identified five main drivers of domestic hand hygiene costs. They did not merely tally up of the raw costs of materials, but included the necessary work of promoting hand hygiene thoroughly, with annual “top up” interventions.

The breakdown of how much money would need to be spent on these one-time and ongoing promotions, handwashing facilities in people’s homes, and soap and water can be seen below:

Handwashing cost breakdown

Over time, the cost of hand hygiene interventions or promotions would diminish, while the estimated cost of soap would increase as a share of the total cost.

The good news is that there is a possibility that promoting hand hygiene could harness “economies of scale and integrating hand hygiene with other behaviour change campaigns where appropriate.”[5] Current or new nation-wide health campaigns could start to incorporate hand hygiene education at a minimal increased cost.

Any discussion of these costs must be had with the knowledge that, as the study highlights, “a substantial disease burden could be averted by hand hygiene.”[6] The human toll of poor hand hygiene is well established, both in sickness and loss of life.

Challenges to accomplishing universal at-home handwashing

While hand hygiene promotion and even the installation of new handwashing facilities would be provided or subsidized by the state or NGOs, the ongoing cost of soap could prove prohibitive. The cost of $17 annually for soap puts handwashing out of reach for the poorest households. To overcome this challenge, the authors propose “further innovation in handwashing technologies that reduce amounts of soap and water needed… [and stimulating] soap markets in countries with particularly high prices.”[7]

There are other challenges, of course, including difficult political and geographical issues. These researchers make no claim to have an answer for all the challenges to implementation. They have, however, done the world a favour by providing the cost of access to at-home handwashing. What we measure indicates what we value. Estimating the cost of providing universal access to handwashing to break the chain of infection is an important first step to realizing this vital project.

[1] Ross, Ian, et al. Costs of Hand Hygiene for All in Household Settings – Estimating the Price Tag for the 46 Least Developed Countries. 24 Aug. 2021, 10.1101/2021.08.16.21262011. Accessed 27 Oct. 2021.

[2] Ross, Ian, et al

[3] Ross, Ian, et al

[4] Ross, Ian, et al

[5] Ross, Ian, et al

[6] Ross, Ian, et al

[7] Ross, Ian, et al

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