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The Handwashing Initiative: selling soap or saving lives?

The World Bank's Handwashing Initiative is based on the conviction that the simple practice of washing hands with soap could reduce deaths from diarrhoea by half. But its intentions are being questioned in Kerala, where people say they need safe drinking water, not multinational soap

Kerala is learning many lessons from global development agencies these days. And it will soon get a few in hygiene. The people of the most literate state in India are to be taught the art of washing their hands with 'good' soap in the coming months. Courtesy the World Bank, scientists from the London School of Hygiene and Tropical Medicine (LSHTM) have designed a handwashing initiative "to reduce the incidence of sanitation-related death amongst children". But the choice of a state that has the lowest incidence of childhood diarrhoea and water-related epidemics could indicate that the project is more about paving the way for the MNCs into the informal personal care market than bringing down the diarrhoeal death rates in the country.

The World Bank-Netherlands Water Partnership, the funding arm of the initiative, inaugurated the ambitious project to promote handwashing at the World Summit on Sustainable Development in Johannesburg recently. Called the Handwashing Initiative, the public-private partnership project aims at promoting the use of soap manufactured by multinational companies to reduce the incidence of diarrhoeal diseases in poor communities. For reasons best known to the project managers, the initiative is being implemented simultaneously in Kerala and Ghana.

It appears that UN agencies will perform their pro-poor obligation of making the communities aware of the virtues of handwashing, but private soap companies will harvest the gains. The project document, prepared by LSHTM and discussed at various fora in Washington DC, New Delhi and Thiruvananthapuram, with no public participation, makes its intentions clear. It offers a win-win approach: whilst governments and development agencies want to combat disease and poverty, industry is interested in expanding its market. But the big question is: should development money be invested in generating profits for the corporate sector?

The Global Initiative for Public-Private Partnerships (PPP) in Handwashing was launched with the aim of meeting "a huge unmet need for handwashing with soap in poor communities in developing countries". The World Bank and the Water and Sanitation Program (WSP) which collaborate with the LSHTM and other partners, have identified multinational soapmakers like Unilever and Colgate Palmolive as partners in this initiative. According to official sources, a meeting in Washington DC on May 7, 2001, attended by representatives from the LSHTM, the governments of Kerala and Ghana and the WSP, decided the specifications of the initiative. Among the 20 participants, Kerala was represented by Elias George of the Kerala Water Authority and James Varghese of the Kerala Rural Water Supply and Sanitation Agency (KRWSA). Vidur Behal of Hindustan Lever India and Diana K Grina of Colgate-Palmolive were also present.

The WSP is an international partnership of the world's leading development agencies "concerned with water and sanitation services for the poor". It receives support from multilateral and bilateral organisations for national, regional, and global activities, including the Asian Development Bank, Australian Agency for International Development, Belgium Agency for Development Cooperation, Canadian International Development Agency, Danish Agency for International Development and the Directorate General for International Cooperation, Netherlands. Its goal is to alleviate poverty by helping the poor gain sustained access to improved water and sanitation services.

The mission statement of the Handwashing Initiative will tell you it aims to bring down diarrhoeal deaths in the world from the present 6,000 deaths every day, to less than 40 per cent. It says lack of sanitation alone is the cause of more than three-quarters of diseases worldwide, and cholera and dysentery, to name a few, account for the death of seven million children every year. The project partners are convinced that handwashing with soap is the most feasible and sustainable option to improve health in the developing countries. A draft report titled Sanitation and Hygiene: Unleashing the Power of the Market prepared by the World Bank and other partners says: "Diarrhoeal diseases kill 2 to 4 million children in developing countries every year. Handwashing with soap alone could cut deaths in half and handwashing with soap combined with adequate sanitation could almost eradicate diarrhoeal diseases." The report also discovers that in developing nations hands are washed with soap on less than 10 per cent of the occasions when they should be!

But some questions remain unanswered: Has there been a serious problem of diarrhoeal deaths in Kerala to merit its being handpicked as one of the two hotspots in the world? Does lack of handwashing really cause outbreaks of water-related epidemics in waterlogged areas such as Kuttanad? Have the people of the state ever been consulted on the washing of their hands with 'good' soap five times a day? Niether Parameswaran Iyer at the Water and Sanitation Program, who co-authored the programme or the Kerala Health Minister P Sankaran provide any answers. "Why should we give up such a chance for a health campaign when the entire amount is met by them?" argues P Sankaran, a lawyer-turned-politician. Officials at the KRWSA in Thiruvananthapuram, the nodal agency for the campaign, are also tight-lipped about the programme.

Nobody in Thiruvananthapuram knows on what basis Kerala was selected for the programme along with Ghana. Some time ago, a survey had been carried out in Thrikkunnappuzha, Alappad and Panmana panchayats along the backwaters in South Kerala on the sustainability of changes in hygiene behaviour. Compiled by Eveline Bolt, IRC International Water and Sanitation Centre, the study concluded that whereas Kerala shows a low mortality rate, it has a high morbidity rate, and the frequently occurring water and sanitation-related diseases point to neglect of hygiene. This report is the only document that the government has to justify Kerala's selection for the campaign.

The villagers in the backwater islets of Kuttanad, however, believe that shortage of safe drinking water and not lack of handwashing is the cause of diarrhoeal outbreaks in Kuttanad. According to Kerala State Pollution Control Board statistics, the coliform bacteria count in 100 millilitres (ml) of water in parts of Kuttanad, is above 48,700 against a permissible 200 in water for human use. No wonder then that outbreaks of epidemics like rat fever and diarrhoea have seen an increase. According to statistics available with the district medical officer, Alappuzha, 18 persons died of wheel's disease in 2002 till October. The count for 2001 was 23. The total number of those suffering from diarrhoea in 2001 was 19,570. Statistics at the Alappuzha Medical College show an increase in filariasis, schistosomiasis, typhoid, jaundice, intestinal cancer, gastroenteritis and cholera. "Give us drinking water first, instead of Palmolive soap," says R Visakhan, the president of the Kainakari Panchayat.

Many in Kerala doubt the intentions of the initiative. "Why preach handwashing when people in Kerala are traditionally conscious about cleanliness and hygiene?'' questions development activist K R Balan. A wide variety of local products are used for personal hygiene in Kerala and an informal market for these products exists in rural areas. There are more than 200 soap manufacturing units in rural Kerala. The award-winning poverty alleviation programme, Kudumbasree, also employs more than 2,500 women in small-scale soap manufacturing units. "This handwashing initiative is a ploy to eat into the existing informal market for these swadeshi soaps,'' says Manoj Arukandathil, General Secretary of the Kerala Small Scale Soap Manufacturers Association.

For Unilever, Colgate Palmolive and Procter & Gamble, it is free promotion. Under the patronage of the UN agencies and governments, these multinational personal care companies stand to make inroads into a hitherto unexplored market segment. The Handwashing Initiative, it is claimed, will open the unexplored global soap market segment of an estimated US $ 20 billion annually.

Multinational giants are upbeat about the new window of opportunity. "It is about increasing the market," remarked Uri Jain, General Manager of Hindustan Lever, one of the prime beneficiaries. Though pushing products amongst the socially disadvantaged isn't new, social investments by the government and UN agencies in the process provides a much-desired legitimacy and a tag of social responsibility to the corporations.

(The Quest Features & Footage)

InfoChange News & Features, November 2002