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Thursday, 2nd May 2019

How do you get kids to wash their hands?

By Millie Giudici

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Painting the new hand washing station at Lanirano Primary School

How do you make sure that kids actually wash their hands? It’s all very well having clean water, and soap, and the knowledge that you should wash your hands. We can tell children, repeatedly, “Handwashing is important!” But sometimes they just don’t bother. Of course, this problem is not limited to children. In 2009, a UK-wide study found that, whilst 99% of adults claim to handwash after using the bathroom, just 62% of women and 32% of men actually do. I will leave you to think about that.

But anyway, how do we get kids to practice good handwashing? To complicate matters, we are asking this question in Madagascar. Madagascar is one of the least developed countries in the world, with 92% of the population estimated to be living below the international poverty line. This time last year, the children of Lanirano Primary School had minimal access to latrines, let alone the facilities to wash their hands. Instead, when they needed to relieve themselves they often defecated openly in the school grounds. And this is not atypical: only 18% of public primary schools in Madagascar have access to a working latrine. So, how do we get these kids, in this context, to wash their hands?

First, we need to provide the children with better access to latrines. Then we need to provide the water, the soap and the knowledge. SEED Madagascar, a British NGO, has been working with Lanirano Primary School to do just this. Since September we have built a three-cubical latrine block on the school site, as well as handwashing facilities (and two new classrooms). Additionally, we have trained and supported the teachers at the school in delivering water, sanitation and hygiene (WASH) education lessons. These lessons not only cover matters of handwashing, but they also teach the children how to identify safe water, how to treat water, and how to use and maintain the latrines.

But is this enough? The children now have access to water, soap, and knowledge. Their teachers have told them, and will keep telling them, ‘Wash your hands!’ But will they? Perhaps. But, as has already been noted, sometimes children just don’t bother. So what can we do? How can we make them wash their hands?

Of course, we are not the first to ask this question. In more prosperous Western countries, ‘nudging’ has gained popularity as a possible answer. Nudges are intentionally created features of an environment which aim to ‘nudge’ a person’s decision making, subconsciously guiding them towards a particular choice. In a child’s bathroom then, you might place an image of footprints on the floor next to a handwashing station, encouraging the child to go there.

A group of researchers trailed this idea in two primary schools in rural Bangladesh. The results were fascinating. Originally, the children only had access to a hand-pump with soap next to it, and just 4% of the children would handwash properly after using the latrine. The researchers then began altering the environment, constructing a clearly designated handwashing station on a raised cement platform. This resulted in 18% of the children washing their hands.

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Trying out the new hand washing station

Next, a brightly coloured pathway was painted, running from the exit of the latrine to the hand-washing station. The majority – 58% of students – now washed their hands. Footprints were added to the path, and handprints were painted on the handwashing station. The figure climbed again. An impressive 68% of students now washed both of their hands with soap after exiting the latrine.

Most excitingly, the researchers discovered that the nudges appeared to have a lasting impact on behaviour. Two weeks after the nudges had been completed 74% of the students washed their hands. And, six weeks later, 74% of students were still washing both hands with soap.

So, how do we get kids to wash their hands? The answer might be to ‘nudge’ them. Inspired by the work in Bangladesh, SEED Madagascar decided to trial this approach at Lanirano Primary School. We constructed a designated handwashing station, with a path running to it from the latrines. We decorated both in brightly coloured foot and handprints, the indents of which were created first in concrete, enabling them to be easily repainted. We also painted the latrine itself, and erected a colourful fence around the site.

To celebrate this new design, the Headmistress of the school suggested that we hold a flower planting day. The children each brought along a cutting, and spent the morning preparing the ground and planting their flowers around the paths. The result was beautiful, adding further colour, and additional motivation to stay on the path. What’s more, it gave the children ownership over their new latrine and handwashing site. But the crucial question remains: do the children now wash their hands? The answer, thankfully, is yes.