hygiene, Monitoring

What counts as a “handwashing facility” in global monitoring?

I’ve previously written about defining hygiene. In this post, I discuss what counts as a “handwashing facility” (HWF) for global monitoring purposes. Points arising that may not be obvious include: (i) an on-plot water point can be considered a HWF if that’s where handwashing is most often practised (e.g. tubewell with handpump, yard tap); (ii) if the HWF most often used is off-plot, that counts as “no service”.

The SDG6 hygiene indicator is the % of people with access to a basic HWF. “Basic” is defined according to the below figure from the JMP 2021 report for households: “availability of a handwashing facility with soap and water at home”. Of greater importance for this post is the note below the figure, which emphasises that HWFs may be (i) located within the dwelling, yard or plot; (ii) fixed or mobile.

Excerpt from JMP 2021 households report

How the question is asked and coded in the latest DHS household questionnaire is below. Key aspects of the question are: (i) if there are multiple places, it’s the one used “most often”, and no specific critical time (after using the toilet, before preparing food) is referred to; (ii) the most-used HWF must be observed – if no handwashing facility is observed or it is off-plot, the household is counted as having “no HWF at home”. If the household does not give permission, or it is not possible to observe for other reasons, it is counted as ‘no permission to see/other’ in survey reports and is excluded from the denominator for JMP service ladders. The DHS interviewer’s manual (p.46) recommends probing to observe mobile HWFs.

Excerpt from DHS household questionnaire

In the note below the JMP 2021 figure above, examples provided of HWFs are a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. However, it is common in many countries and settings to have yard taps from a utility supply, and in some countries (especially in South Asia) to have an on-plot tubewell with handpump. If one of those water points is the place where household members most often wash their hands, then it is natural to interpret that as a fixed HWF. I have clarified with the JMP team that this interpretation is correct.

However, households with water accessible on premises may not necessarily have a “basic” hygiene service, because soap and water must be available at the time of survey (see “limited” category in the figure at the top). In Bolivia for example, 86% of people have improved on-plot water but only 27% have “basic” hygiene, with availability of soap being the limiting factor (see JMP figure below). In analysis of 46 least developed countries for our recent costing study (under review), we established from JMP data that amongst the population with limited services, “missing soap only” was the reason for 47% on average, “missing water only” was 10%, and “missing both” was 43%. So households with a “limited” service are missing soap in 90% of cases.

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