OP-ED: Washing hands, saving lives

 “I already know washing hands with soap for 20 seconds prevents diseases like Covid-19, but how can I do it when I’m out all day with no proper facility around?” asked a resident of Khulna, when asked about his handwashing habits.

The same reality was reflected by 72.6% of over 320,000 people we surveyed, revealing people are cognizant of the benefits of frequent handwashing with soap, but over half of them are unable to comply, owing to unavailability of soap and water when needed.

As part of our FCDO-Unilever Hygiene and Behaviour Change Coalition (HBCC) initiative, BRAC has built 1000 pedal-operated handwashing stations across the country. Our goal was simple -- increase the community’s access to free soap and water, and by nudging people to use the stations, reduce risk of Covid transmission.

At the heart of our handwashing station design lies improved access and efficiency. The stations have been designed to ensure least amount of hand contact, each sink connected to two foot-operated pedals which dispense water and liquid soap. 

Clickers have been attached to the foot pedals, to collect real time data on the usage of the stations. One sink out of the three in every station, is placed at a height accessible to both children and wheelchair users, to ensure that a diverse audience can use our stations. 

We ran two pilots to test the efficacy of our stations to ensure that our model remains usable and beneficial to people in a sustainable way.

The first pilot was to finalize the design of the posters that would go up on the stations. In collaboration with the Behavioural Insights Team (BIT), we tested four variants of posters online on 2,196 Bangladeshi residents, with different posters showcasing a number of steps during handwashing. 

This was done to test both uptake of key handwashing messages (eg, wash for 20 seconds every time) as well as the ability to recall handwashing steps as depicted on the poster. In the second pilot, in partnership with the BRAC Institute of Governance and Development (BIGD) and BIT, we monitored and observed usage of a number of the installed handwashing devices, and interviewed stakeholders from the communities, to generate evidence on the usage and efficacy of the stations.

The pilot revealed that 90% of interviewees recalled the posters at the handwashing stations, indicating the poster’s effectiveness in motivating people to wash their hands. Upon feedback from seasoned field personnel from the BRAC WASH program, we added an extra step, to ensure a more thorough experience.

The stations, which were built around busy locations, expectedly garnered attention from residents, with 96% of people living nearby recalling seeing the stations and being curious to use them. However, the foot-operated pedals stymied some. 

That motivated us to change the posters on the stations to showcase the pedal-operation. We also dyed the pedals in bright orange to bring attention to it, and added stickers on the station, two above each sink, to indicate which pedal would dispense soap and water respectively.

Overall, the pilot revealed that the stations were appreciated by residents, who touted the ready availability of free soap and water, and the presence of the station on their commute routes, as points that would encourage them to use the facilities. 

Taking lessons from the pilots, we have made more improvements to the model and starting from late September, we established 1,000 handwashing stations in less than 12 weeks. Local engineers and technicians were engaged in making the stands, which helped reduce costs while engaging local experts.

While our pilots have indicated the presence of handwashing stations can motivate and improve people’s frequency of handwashing, the challenge lies in turning that into a norm. To turn handwashing at the stations into a habit, we are now priming to try out different nudges -- both environmental and social -- to see what would work best to motivate people to change their handwashing behaviour in the long run.

Shafqat Aurin is an Interaction Designer with the BRAC Social Innovation Lab. Arshae Ahmed is a Project Coordinator for BRAC-HBCC with the BRAC Social Innovation Lab.