Handwashing beyond the pandemic

By Kelvin Tembo

At the peak of the COVID-19 pandemic, Malawi made progress in promoting hand hygiene habits. Buckets with taps stood proudly at the entrances of schools, hospitals, offices, churches, markets, and various public spaces. Bars of soap sat neatly beside them, and so did alcohol-based hand sanitizers.

The message, ‘wash your hands, save your life,’ which was as constant as the virus itself, echoed on radio stations, televisions, newspapers, social media platforms, and posters as the compelling nature of the Coronavirus Disease as a life-threatening illness, forced adherence to basic hygiene protocols.

But five years later, with the fading of COVID-19, that hygiene revolution has quietly faded. A visit to public institutions that once championed hand hygiene reveals a troubling reality: almost all handwashing facilities are gone.

For instance, a visit to Mapale Health Centre in Mzuzu City, a high-risk area for infection transmission, the once-familiar sight of buckets and soap has disappeared. The only surviving handwashing facility was seen at the entrance to the Voluntary Testing Centre (VCT).

“We used to see buckets right from the gate at this facility, and we were asked to wash our hands before entering, but now they are all gone,” says Agnes Msimuko, a Mzuzu resident we met at this health centre. “Everyone just walks in and out, and sometimes I wonder if we only cared because we were scared. It is like we have forgotten everything.”

The situation is the same across various public places in the city and across Malawi. What was once a symbol of national unity against a global threat and a hygiene movement has become a forgotten gesture in daily life.

Ministry of Water and Sanitation spokeperson, James Kumwenda acknowledges the backslide.

“During the pandemic, Malawi demonstrated a notable success in promoting handwashing practices, but we have seen a decline in the habits. This is unfortunate because we needed to embrace this as a daily behavior to have a healthier and a hygienic nation,” Kumwenda says.

He adds, “Hand hygiene is one of the key variables when it comes to the prevention of various diseases. These could be waterborne diseases and other respiratory diseases, whose probability of transmission is heavily reduced when we practice handwashing with soap.”

A habit lost to complacency

The disappearance of handwashing facilities is more than just a physical absence. The trend suggests that Malawi viewed handwashing as a temporary pandemic response rather than a long-term public health habit.

Yet, clean hands remain critical, not just against COVID-19, but against other preventable, communicable diseases linked to sanitation and hygiene like Cholera, which recently hit the country hard, respiratory infections, and partially, MPOX, which is currently haunting.

The Ministry of Health is concerned.

“It is worrisome because, according to our research, over 52 percent of communicable diseases can be prevented through proper hygiene and sanitation. So, handwashing alone can protect us from diseases such as Cholera, MPOX partly, and several other infections, including eye and skin conditions,” the Ministry’s spokesperson Adrian Chikumbe says.

Chikumbe says Malawi’s poor handwashing culture has even distorted disease patterns as well as contributed to the persistence of sanitation and hygiene-related infections.

“When people were washing hands to protect themselves from COVID-19, they were protecting themselves from several other conditions, which was positive. But with low levels of that practice, that is why we now even have Cholera in the dry season and a lot of diseases that could have been prevented,” he says.

Counting the cost of forgetfulness

The figures resulting from the relaxation in promoting handwashing are placing Malawi, a country striving toward achieving Sustainable Development Goal 6 (SDG 6), which calls for clean water and sanitation for all, in a troubling position.

World Health Organization and UNICEF’s Joint Monitoring Programme ranks Malawi among the slowest nations in Southern Africa for progress in promoting access to handwashing with soap.

Ministry of Water and Sanitation estimates that only 19.8 percent of Malawians wash their hands with soap regularly. The practice is more common in urban areas at 38.5 percent compared to 15.4 percent in rural areas. That means, more than 80 percent of the population is at daily risk of contracting preventable diseases, a statistic that silently screams of neglect.

Malawi’s negligence in promoting and sustaining handwashing as one of the key defenses to preventing over half of the diseases linked to sanitation and hygiene is costing lives and money.

For instance, the most recent widely reported Cholera outbreak in the country, which was declared over in July 2024, resulted in over 1,500 deaths from over 59,000 cases since March 2022. Millions were spent in ending the outbreak, which, among the preventive measures, lies the simplest but effective one; handwashing.

The heroes who keep washing

While buckets of water and soap have vanished in many public places, not everyone has given up. At Sonda Primary School in Mzuzu, hand hygiene has remained a daily ritual long after the pandemic faded.

The school continues to uphold the standards introduced during the COVID-19 pandemic by ensuring that every classroom has its own handwashing bucket and soap. Learners are required to wash their hands after using the toilet, before eating, and after outdoor activities, a practice that has become part of the school’s culture rather than a response to emergencies.

Mwiza Phetembe, a Standard Seven teacher who doubles as the school’s Sanitation Coordinator, says they are doing this for disease prevention as well as instilling the culture of hygiene in learners at a tender age.

“We do this to ensure that our learners are protected from germs that transmit diseases so that they do not fall sick. This is a preventive measure because we know that hygiene is central to minimizing transmission of diseases that come due to poor hygiene,” Phetembe says.

“We are also doing this to ensure that our learners grow up with hygiene habits,” she adds.

To fund this initiative, Sonda Primary School uses part of the funds from the School Development Fund, with parents and teachers working together to purchase materials and maintain supplies. The school Management Committee (SMC) also runs fundraising activities to strengthen the hygiene program.

“Sustainability is at the heart of our approach. The school has established a system to ensure the continuity of hygiene practices even when challenges arise,” Joana Mkandawire, SMC Treasurer, says.

She adds; “For instance, we recently bought 16 buckets, which we are keeping as a reserve so that any broken or worn-out bucket is immediately replaced. This preparedness will ensure that there is never a day when learners will go without access to handwashing facilities.”

Can we wash our way back?

Water and Sanitation Hygiene (WASH) advocates and Health Rights Campaigners believe this can be achieved. They agree on the need to revive the handwashing culture and treat the practice beyond responding to emergencies.

Water and Environmental Sanitation Network (WESNET) Communications Officer Angella Phiri notes that there is a need for every individual to be a champion of handwashing by reminding one another to continue practicing handwashing habits, for the country to deal with diseases linked to poor sanitation and hygiene.

“It is also best for every institution, whether schools, hospitals, the markets, or at an office or shops, to put up handwashing facilities, so that whenever people come to access their services or to buy their goods, they should be able to wash their hands,” Phiri says.

WASH Media Forum Chairperson Meclina Chirwa agrees. She believes the key lies in integration, advocacy, and keeping hygiene in the national conversation.

“We need to integrate hand hygiene promotion into existing health programs and community activities, collaborate with healthcare providers, and incorporate hand hygiene into existing health campaigns such as vaccination programs or disease prevention initiatives,” Chirwa says.

She adds, “We can also utilize media platforms to raise awareness, as journalists, we can also create engaging content, we can also collaborate with influencers such as celebrities, community leaders to champion hand hygiene, and encourage community-led initiatives.”

Furthermore, Chirwa says there is a need to advocate for increased funding and resources to support hand hygiene infrastructure.

“We can lobby the government, donors, and private sector organizations to invest in hand hygiene infrastructure such as handwashing stations and sanitation facilities. We can also advocate for increased funding for hand hygiene education and promotion programs, particularly in underserved communities,” she says.

For Health rights campaigner George Jobe, the situation calls for collective action and accountability from the Government, development partners, institutions, workplaces, schools, and communities to make hygiene a sustained national priority.

“We need to invest in WASH infrastructure by ensuring consistent availability of safe water and functional handwashing stations, monitor and report progress by developing accountability systems that track hand hygiene access and practices, and share findings regularly to strengthen transparency and action,” Jobe says.

But for Patrick Msowoya, a vendor from Mzuzu, returning to how things were five years ago is a good starting point.

“Government, city and town councils should remind people again. Even just one bucket at every entrance of the market or bus depots could make a big difference,” Msowoya says.

A reminder from the world

On October 15, Malawi joined the world in commemorating Global Handwashing Day, an event that seeks to elevate awareness about the pivotal role of handwashing with soap in disease prevention and saving lives.

The day was commemorated under the theme ‘Be a handwashing hero.’ The theme underscored the individual and collective urgency to positively impact public health outcomes. It served as a clarion call to action, encouraging individuals across various settings to champion exemplary hand hygiene practices and cultivate a universal culture of clean hands.

Back home, the Ministry of Water and Sanitation used the occasion to urge citizens to use the day as a call to restore the culture of clean hands and to make hygiene a shared responsibility once again.

Principal Secretary in the Ministry Elias Chimulambe reminded the nation that the fight against infections begins with something as simple as soap and water.

“Clean hands are a crucial defense against disease,” he said in a statement. “By working together, we can build a safer and healthier Malawi.”

Moving forward

Ministry of Water and Sanitation spokesperson says the ministry is not relenting in its efforts to promote hand hygiene. He says together with stakeholders they are continuously advising the public to take handwashing as a daily habit and as something key for a healthier and productive nation.

“We have enhanced community sensitization efforts, we are leveraging strategic communication approaches to promote behavioral change, we have intensified hygiene promotion campaigns through a range of events and observances, and we have been promoting WASH Innovation Fairs,” Kumwenda says.

“Let us take this behavior as a routine practice rather than a response to a specific pandemic. The importance to the overall development of the country cannot be overemphasized. This contributes to a healthier labor force, which is a key variable to a productive labor force and key to the development of the nation,” he adds.

At the Ministry of Health, Adrian Chikumbe echoes the same message.

“People need to make handwashing with soap a way of life. Most of the time, we get in contact with germs without knowing, and with proper handwashing with soap, we can protect ourselves from getting infected. If we cannot handwash with soap, then be in the habit of having at least a hand sanitizer,” Chikumbe says.

A question to the nation

Malawi has policies, strategies, and plans from the National Sanitation and Hygiene Strategy to the Malawi 2063 Agenda, all emphasizing hygiene as a cornerstone of development. But on the ground, the absence of water buckets and soap tells another story. A story of a nation that moved too quickly from a hard-earned lesson.

Five years ago, the sound of running water symbolized fear and survival. Today it should symbolize wisdom and lessons learned.

And so, the question arises.

Must another deadly pandemic strike before Malawi washes its hands again?

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