Guest author Joshua Briembergis a WaterAid Country Representative in Nicaragua.

Handwashing is a habit, or at least it should be if we hope to positively impact the health and well-being of the impoverished populations of Nicaragua.  Those of us who work in the water, sanitation and hygiene (WASH) sector read studies that repeatedly demonstrate the link between correct handwashing and the reduction of diarrhea, one of the leading causes of under-five preventable child deaths.  We then go further, to make the link between a reduction in diarrhea and the benefits this brings: more schooling, less malnourishment, savings on medical treatment and more productive lives, and greater happiness.

Still, during a forum of WASH professionals to discuss progress in sanitation a year ago, a secret survey of the participants as they left the toilet facilities showed that less than 60 percent of both men and women practiced handwashing at this critical moment.  These are alarming results, especially since the participants had access to a clean hotel washroom with amenities in a capital city.  Not long after, at a meeting at the Ministry of Health headquarters precisely to discuss a handwashing campaign, one participant noted that there was no soap to enable proper handwashing practice in the washroom facilities.

In the villages and poor urban slums where WaterAid focuses its attention, most of the general public who we work with on a daily basis is able to identify handwashing as a good hygiene habit.  But there is a big difference between knowledge and practice, and this is the challenge WaterAid’s hygiene promotion programs seek to address.

According to the Nicaragua Ministry of Health, acute diarrhea illness in 2008 affected 572.1 of every 10,000 inhabitants (or 5.7% of the population) with a death rate of 4.3 per 100,000 inhabitants (total population), and 20.8 per 100,000 inhabitants in children under age five.

Sure, the minimal conditions are often lacking: running water, soap, hand towels, and adequate provision for wastewater drainage.  Schools, kitchens and toilets are often built without handwashing facilities and when they are, the handwashing facilities are typically not conveniently located, which is important to the process of teaching good habits.

As these problems are addressed by WaterAid with low-cost provision of handwashing facilities next to toilets, within classrooms, and near to areas for food preparation and eating, leading by example remains a powerful tool. During all of our vocational and professional development training sessions with municipal WASH technicians, community water user association operators, teachers and health workers, the rules of order go beyond those of mutual respect, punctuality, and other common meeting ground-rules, to include good hygiene practices. Handwashing before eating and after using the toilet is at the top of the list.

As we saw at the sanitation conference, old habits often die hard.  No matter what facilities are available it can take time and plenty of reinforcement for the habit of handwashing to become ingrained, so repetition of hygiene promotion messaging is vital.

Children tend to be the most receptive audience for handwashing promotion.  Without a lifetime of habits to unlearn, they are generally a lot more amenable to new ideas.  In Nicaragua and around the world, WaterAid works with schools to develop fun hygiene promotion programs, which help kids to understand the health benefits of handwashing and untap their potential to act as ambassadors of good hygiene within their families and the wider community.

But you too can be a handwashing ambassador.  Global Handwashing Day is October 15—on this day and every day, remember to wash your hands, and model healthy behaviors that will last a lifetime!