Handwashing Could Save One Million Children’s Lives Each Year

The simple habit of handwashing, if widely adopted, would save more than one million lives around the world yearly, most of them children under the age of five in poorer countries. The challenge has been taken up by PHASE, a public health and education programme dedicated to fighting infectious diseases through personal hygiene and sanitation.

The two biggest killers of children age five and below are diarrhoea and pneumonia, both of which can be reduced by handwashing.

The PHASE programme – a partnership of GlaxoSmithKline (GSK), the international research-based pharmaceutical company and two non-governmental organisations, AMREF (African Medical and Research Foundation) and Plan International trains children through the school system of each country, who are taught to encourage handwashing and other sanitary practices in their families.

“This programme has transformed personal hygiene and sanitation in the countries we work. If the approach is adopted in other developing countries, it could make a major difference to saving children’s lives”, says Claire Hitchcock, GlaxoSmithKline’s Director of Europe and International Community Partnerships and the GSK PHASE coordinator.

The best method is to use soap with water to wash hands, but PHASE suggests alternatives if soap is not available.

“If you don’t wash your hands after using the toilet, your hands become a superhighway for transmitting microbes from one person to another,” says Valerie Curtis PhD, director of the Hygiene Centre at the London School of Hygiene and Tropical Medicine, a global expert on the beneficial effects of handwashing. “Faeces contain billions and billions of viruses and bacteria. They are public enemy number one in spreading these killer diseases to children.”

PHASE began in 1998 and now operates in four countries – Kenya and Zambia in Africa, and Nicaragua and Peru in Latin America — but its system can be easily replicated throughout the world.

“PHASE rests on three main pillars – handwashing, greater access to water and safer excreta disposal,” says Ms Hitchcock. “Nearly 40 percent of the world’s population, or 2.4 billion people, still have no access to hygienic means of personal sanitation.”

Diarrhoeal diseases kill nearly 2 million children under the age of five each year around the world, which is approximately 15 percent of all child deaths in this age group. Eighty to ninety percent of these cases are related to environmental conditions, in particular contaminated water and inadequate sanitation.

However, research has also shown a strong link between handwashing and a decrease in respiratory infections, which cause nearly four million deaths each year, mostly children. A US Navy study showed handwashing reduced the risk of respiratory infections among training recruits by as much as 45 percent.

“Almost every family in the world has soap in some form in their homes, but people don’t always use it to wash their hands, especially after using the toilet and before preparing food,” says Dr Curtis. “This lack of habitual handwashing after using the toilet is a fact in both developing and developed countries.”

PHASE PROGRAMME — PHASE, which stands for “Personal Hygiene & Sanitation Education”, decided to focus on teaching the handwashing regimen directly to children, who would teach other children, and their parents.

Working closely with Ministries of Health and Education in the programme countries, PHASE combines a holistic approach to healthcare, education, community development and water/sanitation. Education materials are carefully designed in consultation with children to be culturally appropriate, and teachers and community leaders receive specialist training to deliver the programme in schools for children aged between 6–13.

“It is vital to learn good sanitary habits in school, so that children develop life-long habits and bring their information home,” says Ms. Hitchcock. “Children at this period of their lives are most susceptible to developing good habits. We have noticed an increase in both the children’s and teachers’ confidence and self-esteem.”

Francis Namisi of African Medical and Research Foundation (AMREF), PHASE project manager for Kenya, says that even washing hands in just cold water is better than nothing. In the Kenyan programme, the local alternatives of washing hands with ash or with herbal leaves are encouraged alongside soap. The alternatives are particularly handy for families that cannot afford soap.

“The path to good hygiene relies on repeated, coherent and simple messages,” Mr. Namisi adds. “In Kenya, our programme involves training two teachers in each of the 247 schools in which we are working. These teachers then teach a core group of students intensively, who act as leaders for the rest of the students.”

“We have found that by actually involving children in the design and validation of the project materials they have a greater understanding of the messages and commitment to increasing the health of their communities”, says Patricia Ray, Programme Manager at Plan UK.

“Teachers and children clearly understand the project’s messages as these are very simple, but the results show that these simple messages are very effective in changing behaviour and improving children’s health”, reports Plan field worker Alejandro Herrera, based in Puira, Peru.

Students are encouraged to create their own folk songs or poems that encompass the PHASE programme messages. They also create signs to place near latrines to remind both children and adults to use nearby handwashing facilities.

Some of the other preventative action the teachers encourage is keeping animals away from the home, building latrines and keeping them clean, making drying racks for kitchen utensils, wearing footwear in latrines, and safe waste disposal.

PHASE assessments have shown:

  • In Kenya, PHASE reaches 83,000 children in 247 schools. In the communities, access to water sources and water collection has improved through increased access to protected water sources such boreholes hence reducing the chances of collecting water from contaminated streams or rivers.
  • In the Ongielo community in Kenya, the reported incidence of diarrhoea in the participating schools has reduced from 650 in 2000 to 215 in 2002. In an adjacent community that is not participating in PHASE, the incidence of diarrhoea has increased from 670 in 2000 to 905 in 2002.

  • In Peru and Nicaragua PHASE reaches more than 47,000 children in schools and informal youth groups. Plan International provides water and sanitation facilities to the participating communities. In 2003, the Peruvian Ministry of Health agreed to expand the programme to all 1200 schools in the country over the next three years. In Nicaragua, the number of families showing improved hygiene practices in handling and conserving drinking water has tripled from 33.5 percent to 91.4 percent.

    In Nicaragua, families with school-aged children that have access to safe water in the participating communities have increased from 58 percent to over 78 percent. In participating schools in Peru, children’s personal hygiene and sanitation practices have improved and handwashing after using the toilet has increased from 15 to 46 percent.

  • In Zambia, GSK works with the Ministry of Education and USAID. Some 60 schools across Zambia are participating in this pilot phase.

“The African experience has shown that water hygiene infrastructure is a necessary prerequisite for PHASE success. Then through children as the agents of change in their communities, real change is possible”, says Gershom Musonda, coordinator of PHASE in Zambia.

PHASE currently reaches more 200,000 children ages and their extended families. GSK has so far contributed £1.5 million to PHASE and pledges to continue the programme because the impact has been so positive.

PHASE is part of GSK’s Global Community Partnerships Programme that aims to improve the quality of life of under-served people in the developing and developed world. The initiative was developed when GSK and its partners identified personal hygiene and sanitation as a neglected health education priority through a series of consultation workshops with health education specialists, government health officials, non-governmental organisations and others.

PHASE contributes to the UN Millennium Development Goals by aiming to reduce the mortality of young children, decrease the spread of disease and by bringing together business, NGOs, governments and communities to improve the lives of people in the developing world.

“Promoting handwashing as a way of reducing disease transmission could be a very effective way to help us reach the millennium goal of reducing child mortality by 2015”, says Dr. Curtis.


Today PHASE will receive an ICC-UNDP-IBLF World Business Award in support of the Millennium Development Goals from the International Chamber of Commerce (ICC) at their 35th World Congress. These are the first worldwide business awards to recognise the significant role business can play in the implementation of the UN’s targets for reducing poverty around the world by 2015. The awards are being presented on 8th June in Marrakesh, Morocco, by the ICC in association with the UN’s Development Programme (UNDP) and the Prince of Wales International Business Leaders Forum (IBLF).

There are already plans to expand PHASE. Plan International and AMREF will be rolling out the programme to other countries. GSK have also allocated funding to facilitate expansion into India, Uganda and Latin America.

“We want to see PHASE embedded in school curricula around the developing world, and taken on by ministries, non-governmental organisations and other private corporations.” says Claire Hitchcock, GSK.

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African Medical and Research Foundation (AMREF) is a non-profit organisation working to improve the health of disadvantaged people in Africa. AMREF website: www.amref.org

Plan International is an independent organisation dedicated to working with and for children. Plan International website: www.plan-international.org

World Business Awards website www.iccwbo.org/awards

GlaxoSmithKline website www.gsk.com/community

London School of Hygiene & Tropical Medicine website www.lshtm.ac.uk

Pictures related to handwashing are available on GSK website: http://gsk.com/community/phase.htm[/sws_white_box]

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