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For decades, people in Uganda have been encouraged to wash their hands as a way of preventing the spread of diseases. However, the percentage of the population accessing and using hand washing facilities remains low at only 36%. What are the challenges?
The hand washing campaign is not new in Uganda. Over 60 years ago, religious leaders were already telling people to wash their hands and avoid spreading diseases. Take the story of President Yoweri Kaguta Museveni, who was the Guest of Honour at the Global Hand Washing Day celebrations on Friday 14th October at Kamuli District in Eastern Uganda.
President Museveni narrated that over 60 years ago when he got confirmation as an Anglican boy, the Bishop advised them to always receive Holy Communion with their left hands because the right hands were dirty from greeting people and touching things. The Bishop's assumption was that everyone was right-handed, or that their left hands didn't touch anything else. Still, the fact remains that sensitisation about hand washing has been with us for over 60 years. So the question is: why after these many years do only 36% of Ugandans have access to hand washing facilities? Moreover, access to a hand washing facility may not necessarily indicate its use.
Efforts to accelerate hand washing with soap in Uganda started in 2006, with the key indicator being the percentage of people with access to (and using) hand washing facilities, with a focus on households and schools. Over the past ten years, this percentage has increased from 14% in financial year 2006/07 to 36% in 2015/16 at household level. At school, the percentage fell from 41% in 2006/7 to 34% in 2015/16.
Different speakers at the Global Hand Washing Day commemoration event highlighted some key challenges as relating to limited supply of water and soap; mindsets and behaviours, poverty and ignorance.
The Chairperson of the National Hand Washing Steering Committee, Engineer Joseph Eyatu noted that one of the key challenges is lack of access to water, especially in the rural areas. There are 60,000 villages and over 10,000 water sources in Uganda. But while the government wishes every village to have at least one source of water, there are some villages that still have none. The available water sources are not evenly distributed. Without access to safe water, hand washing with soap will remain a distant dream.
The Minister of State for Environment, Hon Mary Kitutu noted that even where there is adequate water, the culture of hand washing is lacking. For example, while 67% of the population has access to safe water, only 36% have access to hand washing facilities. In Kamuli District where the day was commemorated, access to safe water is 76%; latrine coverage is 70%, yet hand washing is at 38%. "Water is available but the practice of hand washing is not ingrained," Kitutu said.
The Minister attributed the situation to citizens' mindset and ignorance. "Many people do not know the critical times when they are supposed to wash their hands with soap. They think hand washing only applies to eating food. If you tell people to wash their hands they ask: what are we going to eat?" Kitutu said.
So what's to be done to change the mindset and accelerate the practice of hand washing with soap?
First of all people need to appreciate the importance of washing hands with soap. It has been proposed over and over again that washing hands is a sure way to prevent diseases – over 60% of the disease burden could be reduced if people practised hand washing.
President Museveni who has known the importance of hand washing since he was a young boy advises that although his Bishop told them that the left hand was cleaner than the right hand, it is important to wash both hands with soap. "I have been trying to understand the science of spreading disease through human contact," Museveni said. "Shaking hands is dangerous because it spreads diseases. Wash your hands whenever you visit the toilet otherwise you spread biological poison," he added.
Museveni even told people how exactly to wash their hands: "Wash the palms, the fingers, between the fingers and then behind the palms," he said as he demonstrated proper hand washing. He encouraged the District Health teams to teach people about all matters of public health, including hand washing.
The Minister of Environment, Mary Kitutu reaffirmed that the Ministry of Water and Environment was working tirelessly to increase water supply and to ensure that each village got at least one source of water.
The Chairperson of the Hand Washing Steering Committee Engineer Eyatu called for increased funding for hand washing and encouraged actors especially at district level, to integrate the hand washing message in all their programme activities.
Most importantly, people at the event were encouraged to "make hand washing a habit" – which was also the theme of the day.
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