Why water, sanitation and hygiene are vital to eliminate NTDs

Social behaviour change (SBC)

Social behaviour change, which aims to improve people’s health by influencing their knowledge, attitudes and social norms, underpins many WASH initiatives. For instance, open defecation or sharing a living space with livestock may be ingrained in some communities, but these practices are potentially harmful because they help trachoma and other NTDs to spread.

There is no ‘one-size-fits-all’ solution for the WASH approach, as customs and practices are culturally unique so the method needs to be tailored to each area. We often work in collaboration with national ministries of health and education to spread the message about face washing through existing school health clubs, as well as by training teachers and providing activities to engage children. We also support ‘community-led total sanitation and hygiene’ (CLTSH) activities, which encourage communities to assess their own sanitation needs and take action to avoid open-air defecation. Our work encourages communities to demand good-quality water and sanitation infrastructure.

As well as helping to prevent the spread of infectious diseases, WASH is crucial to treat and care for people affected by them. Having safe water sources is important to care for patients. For example, in the Democratic Republic of Congo, health workers are teaching people with lymphatic filariasis (LF), who are affected with swelling of the limbs, to care for their symptoms. Access to clean water is critical for these patients to keep their limbs clean and decrease the chance of infection.

With children, the simple act of hand and face washing with soap can help reduce the risk of trachoma by 60 per cent. That’s why in 2014 Unilever and Sightsavers created the Super School of Five, inspired by Lifebuoy soap’s ‘School of Five’ hand washing campaign. This innovative programme features five cartoon superheroes who help children to remember the five key times in the day when they should wash their hands and faces.

The impact has been huge – an evaluation of participating schools in Turkana, Kenya, found face and hand washing increased by 40 per cent, a level of change that was still in place 20 months after the programme ended.

Both the Ascend West and Central Africa programme and the Accelerate trachoma elimination programme ensure their activities include WASH. For example, the Accelerate programme reaches some of the most disenfranchised communities in trachoma-endemic areas with WASH services and supports intensified hygiene-related behavioural change in seven countries, to help break the transmission of trachoma.

WASH and COVID-19

We are proud that we were able to use our WASH expertise to help governments respond to the COVID-19 pandemic. The Ascend programme worked with ministries of health and national task forces across West and Central Africa to identify areas of need, ensuring we provided support where requested from national COVID-19 plans. We worked together with governments and partners to roll out hygiene-related behaviour change campaigns, for instance, by creating COVID-19-related posters and billboards in local languages. You can see an example from Nigeria, below:

Extensive WASH and NTD data from local districts in countries where we work is now being collected and stored in a central database. This includes data on access to safe drinking water, sanitation and waste management; hand and face washing stations; and hygiene levels in schools and health facilities. Data from both areas is then analysed together, creating knowledge on how to create more effective NTD and WASH programmes, and greater collaboration between key players.

By showing that working together on WASH can control multiple diseases, we hope that more support for multi-sector initiatives will emerge, alongside increased investment to improve WASH-related infrastructures.