Portable Hand-Wash Stations for COVID-19 Prevention
Summary
Rwanda's quick response to COVID-19 in early 2020 entailed the installation of portable hand-wash stations across the country. In Kigali, hand-wash stations were set up in entrances of public spaces, including bus stations, markets, churches, and banks, as part of the Rwandan government's strategy first line of defense against COVID-19. Rwanda also used portable hand-washing stations during the Ebola epidemic. The simple technology makes them a promising solution worldwide in urban and rural settings.
Before the COVID-19 pandemic, 13% of urban Rwandan households had a hand-washing facility with both soap and water available despite relatively high awareness of the importance of hand-washing (USAID, 2021). The pandemic has reinforced the importance of washing hands with soap and water, a simple preventative measure that acts as a first line of defense in stopping the spread of multiple viruses and bacterial pathogens (Alyzood et al., 2020).
Intervention
In light of the COVID-19 pandemic, the Rwandan government, with support from development organizations , rapidly installed hand-washing stations at all health facilities' points of entry, as well as public spaces, including markets, churches, bus terminals, banks, and restaurants, as part of the Rwandan Coronavirus National Preparedness and Response Plan (Uwiringiyimana, 2020; Karim et al., 2021). On March 11, 2020, Kigali installed the first handwashing stations in response to COVID-19 (USAID, 2021).
The hand-wash stations, modeled after the kandagira ukarabe - a Kinyarwanda word for 'step on and wash', employ a simple technology that involves a small jar or container filled with clean water that connected to a pedal that exerts pressure to open the flow of water from the container (New Times, 2011). The idea of portable hand-wash sinks in Rwanda was developed by ECOMEM CO. Ltd., a Kigali-based company specializing in the supply and distribution of construction and sanitization materials (Kantengwa, 2020). The company distributed sanitation products, including portable hand-wash sinks, when Ebola broke out in 2018, which necessitated an alternative to the previous solution of shared water basins under a tap (Kantengwa, 2020). ECOMEM Co. partnered with SATO, a sanitation equipment company, to deliver compact and portable sink stations, each with a hands-free water dispenser activated by a foot pump and a drainage hose length of 2.7ft (Kantengwa, 2020).
The installation of hand-wash stations was part of an extensive government-led prevention awareness campaign that urged citizens to wash or sanitize their hands regularly and avoid handshake greetings to prevent the spread of COVID-19 (Karim et al., 2021). Rwanda's Ministry of Health continually advised citizens to wash their hands regularly and practice physical distancing, noting that hand-washing is critical in the fight against COVID-19 (Karim et al., 2021). Hand-wash stations or sanitizers became compulsory at entrances to public places (USAID, 2021). Rwanda's strong governance and experience in combating the Ebola virus enabled the rapid installation of hand-wash stations, in addition to other COVID-19 treatment and prevention measures (i.e., training health workers, establishing contact tracing networks, and treating high-risk areas) (Diop, 2020). Rwanda's water tariffs were not formally relaxed despite the increased calls to wash hands regularly with soap and water (USAID, 2021). As economic activities slowed during the pandemic in Rwanda due to lockdown restrictions, many families reported income losses which might have resulted in a shift to lower quality sources of water at the household level (i.e. moving away from bottled water and treated water vended in 20L jerry cans to public standpipes) (USAID, 2021). Much of the financial support for the hand-wash stations project has come from organizations including the World Bank, WHO, IMF, the European Union, and USAID.
Challenges
Presently, two significant challenges to Kigali's portable hand-wash stations exist: insufficient numbers of hand-wash stations around the city and inadequate quantities of water supplied to the stations. Both challenges have been identified through anecdotal reports however, due to data limitations, it is difficult to obtain a complete picture of the situation on the ground. First, it is challenging to manufacture portable hand-wash stations on a large scale, compounded by production delays (Kantengwa, 2020). Second, each hand-wash station is connected to a tank that holds water, which must be emptied and refilled regularly. Kigali, and Rwanda more broadly, are known to have chronic infrastructure challenges that make it challenging to provide a reliable, adequate supply of water to every hand-wash station (USAID, 2021). For the hand-wash stations that exist, it is also difficult to enforce compliance with the regulation, which varies in public places (USAID, 2021). There have also been indications of a modest decline in self-reported hand-washing following eased COVID-19 restrictions; however, it is difficult to predict sustained hand-washing behavior change due to no historical precedent (USAID, 2021).
While the Rwandan government reacted quickly by installing hand-washing stations in healthcare and public settings, to combat the onset of COVID-19, inadequate quantities of water supplied to the much-used stations due to chronic infrastructure problems make it challenging to determine whether hand-washing as a social norm became entrenched in Rwandan society.
Outcomes
Rwanda acted swiftly in the face of COVID-19, imposing a total lockdown when the country had 18 confirmed cases, most of which were in travelers and their close companions (Semakula et al., 2021). While Rwanda's COVID-19 cases were relatively low in 2020 and the first half of 2021, they spiked in Summer 2021, with a 7-day rolling average of close to 1,400 cases in mid-July (Ritchie et al., 2021). Self-reported handwashing rates during the pandemic were high, with 87% of respondents reporting washing their hands more often (USAID, 2021). Several development agencies, nonprofits, and private organizations have also set up free hand-washing stations and have distributed free soap throughout the pandemic (USAID, 2021). It is anticipated that the pandemic has resulted in a positive social norms shift concerning hand-washing. 57% of respondents to the survey mentioned above noted that neighbors wash hands with soap "much more" than pre-COVID-19, and another 31% report neighbors washing hands with soap 'a bit more' (USAID, 2021).
References
Portable Hand-Wash Stations for COVID-19 Prevention
Summary
Rwanda's quick response to COVID-19 in early 2020 entailed the installation of portable hand-wash stations across the country. In Kigali, hand-wash stations were set up in entrances of public spaces, including bus stations, markets, churches, and banks, as part of the Rwandan government's strategy first line of defense against COVID-19. Rwanda also used portable hand-washing stations during the Ebola epidemic. The simple technology makes them a promising solution worldwide in urban and rural settings.
Before the COVID-19 pandemic, 13% of urban Rwandan households had a hand-washing facility with both soap and water available despite relatively high awareness of the importance of hand-washing (USAID, 2021). The pandemic has reinforced the importance of washing hands with soap and water, a simple preventative measure that acts as a first line of defense in stopping the spread of multiple viruses and bacterial pathogens (Alyzood et al., 2020).
Issue
Intervention
In light of the COVID-19 pandemic, the Rwandan government, with support from development organizations , rapidly installed hand-washing stations at all health facilities' points of entry, as well as public spaces, including markets, churches, bus terminals, banks, and restaurants, as part of the Rwandan Coronavirus National Preparedness and Response Plan (Uwiringiyimana, 2020; Karim et al., 2021). On March 11, 2020, Kigali installed the first handwashing stations in response to COVID-19 (USAID, 2021).
The hand-wash stations, modeled after the kandagira ukarabe - a Kinyarwanda word for 'step on and wash', employ a simple technology that involves a small jar or container filled with clean water that connected to a pedal that exerts pressure to open the flow of water from the container (New Times, 2011). The idea of portable hand-wash sinks in Rwanda was developed by ECOMEM CO. Ltd., a Kigali-based company specializing in the supply and distribution of construction and sanitization materials (Kantengwa, 2020). The company distributed sanitation products, including portable hand-wash sinks, when Ebola broke out in 2018, which necessitated an alternative to the previous solution of shared water basins under a tap (Kantengwa, 2020). ECOMEM Co. partnered with SATO, a sanitation equipment company, to deliver compact and portable sink stations, each with a hands-free water dispenser activated by a foot pump and a drainage hose length of 2.7ft (Kantengwa, 2020).
The installation of hand-wash stations was part of an extensive government-led prevention awareness campaign that urged citizens to wash or sanitize their hands regularly and avoid handshake greetings to prevent the spread of COVID-19 (Karim et al., 2021). Rwanda's Ministry of Health continually advised citizens to wash their hands regularly and practice physical distancing, noting that hand-washing is critical in the fight against COVID-19 (Karim et al., 2021). Hand-wash stations or sanitizers became compulsory at entrances to public places (USAID, 2021). Rwanda's strong governance and experience in combating the Ebola virus enabled the rapid installation of hand-wash stations, in addition to other COVID-19 treatment and prevention measures (i.e., training health workers, establishing contact tracing networks, and treating high-risk areas) (Diop, 2020). Rwanda's water tariffs were not formally relaxed despite the increased calls to wash hands regularly with soap and water (USAID, 2021). As economic activities slowed during the pandemic in Rwanda due to lockdown restrictions, many families reported income losses which might have resulted in a shift to lower quality sources of water at the household level (i.e. moving away from bottled water and treated water vended in 20L jerry cans to public standpipes) (USAID, 2021). Much of the financial support for the hand-wash stations project has come from organizations including the World Bank, WHO, IMF, the European Union, and USAID.
Challenges
Presently, two significant challenges to Kigali's portable hand-wash stations exist: insufficient numbers of hand-wash stations around the city and inadequate quantities of water supplied to the stations. Both challenges have been identified through anecdotal reports however, due to data limitations, it is difficult to obtain a complete picture of the situation on the ground. First, it is challenging to manufacture portable hand-wash stations on a large scale, compounded by production delays (Kantengwa, 2020). Second, each hand-wash station is connected to a tank that holds water, which must be emptied and refilled regularly. Kigali, and Rwanda more broadly, are known to have chronic infrastructure challenges that make it challenging to provide a reliable, adequate supply of water to every hand-wash station (USAID, 2021). For the hand-wash stations that exist, it is also difficult to enforce compliance with the regulation, which varies in public places (USAID, 2021). There have also been indications of a modest decline in self-reported hand-washing following eased COVID-19 restrictions; however, it is difficult to predict sustained hand-washing behavior change due to no historical precedent (USAID, 2021).
While the Rwandan government reacted quickly by installing hand-washing stations in healthcare and public settings, to combat the onset of COVID-19, inadequate quantities of water supplied to the much-used stations due to chronic infrastructure problems make it challenging to determine whether hand-washing as a social norm became entrenched in Rwandan society.
Outcomes
Rwanda acted swiftly in the face of COVID-19, imposing a total lockdown when the country had 18 confirmed cases, most of which were in travelers and their close companions (Semakula et al., 2021). While Rwanda's COVID-19 cases were relatively low in 2020 and the first half of 2021, they spiked in Summer 2021, with a 7-day rolling average of close to 1,400 cases in mid-July (Ritchie et al., 2021). Self-reported handwashing rates during the pandemic were high, with 87% of respondents reporting washing their hands more often (USAID, 2021). Several development agencies, nonprofits, and private organizations have also set up free hand-washing stations and have distributed free soap throughout the pandemic (USAID, 2021). It is anticipated that the pandemic has resulted in a positive social norms shift concerning hand-washing. 57% of respondents to the survey mentioned above noted that neighbors wash hands with soap "much more" than pre-COVID-19, and another 31% report neighbors washing hands with soap 'a bit more' (USAID, 2021).
Issues |
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Water Health and Safety |
Solutions |
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Community Engagement & Education |
References
Alzyood, M., Jackson, D., Aveyard, H., & Brooke, J. (2020). Covid‐19 reinforces the importance of handwashing. Journal of Clinical Nursing, 29(15-16), 2760-2761. doi:10.1111/jocn.15313
Assessing the Effects of COVID-19 on Access to Water, Sanitation, and Hygiene in USAID High Priority and Strategy-Aligned Countries : Country Deep Dive Supplementary Report - Rwanda. (2021, February). Retrieved October 06, 2021, from https://pdf.usaid.gov/pdf_docs/PA00XDN2.pdf
Bringing sanitation products closer to communities. (2019, August). Retrieved November 01, 2021, from https://snv.org/update/bringing-sanitation-products-closer-communities
Diop, C. (2020, July 24). Pandemic in the land of a thousand hills: Rwanda and covid-19. Retrieved October 12, 2021, from https://munkschool.utoronto.ca/pandemic-in-the-land-of-a-thousand-hills-rwanda-and-covid-19/
Introducing Rwanda's 'step and wash' technology. (2011, February 17). Retrieved October 12, 2021, from https://www.newtimes.co.rw/section/read/96785
Kantengwa, S. (2020, August 03). The portable handwashing sinks that got people talking about Rwanda. Retrieved October 11, 2021, from https://www.newtimes.co.rw/news/portable-handwashing-sinks-got-people-talking-about-rwanda
Karim, N., Jing, L., Lee, J. A., Kharel, R., Lubetkin, D., Clancy, C. M., . . . Ndebwanimana, V. (2021). Lessons learned from Rwanda: Innovative strategies for prevention and containment of covid-19. Annals of Global Health, 87(1), 23. doi:10.5334/aogh.3172
Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., . . . Roser, M. (2021, October). Rwanda: Coronavirus pandemic country profile. Retrieved October 12, 2021, from https://ourworldindata.org/coronavirus/country/rwanda
Semakula, M., Niragire, F., Umutoni, A., Nsanzimana, S., Ndahindwa, V., Rwagasore, E., . . . Faes, C. (2021). The secondary transmission pattern of COVID-19 based on contact tracing in Rwanda. BMJ Global Health, 6(6). doi:10.1136/bmjgh-2020-004885
UNICEF. (2019, May). Hand-washing during an epidemic - Democratic Republic of the Congo. Retrieved October 14, 2021, from https://reliefweb.int/report/democratic-republic-congo/hand-washing-during-epidemic
Uwiringiyimana, C. (2020, March 11). Rwanda keeping coronavirus at bay with campaign of public handwashing. Retrieved October 10, 2021, from https://www.reuters.com/article/us-health-coronavirus-rwanda-idUSKBN20Y2R8
World Bank. (2020, April 30). Covid-19 makes handwashing facilities and promotion more critical than ever. Retrieved October 14, 2021, from https://www.worldbank.org/en/news/feature/2020/04/30/covid-19-makes-handwashing-facilities-and-promotion-more-critical-than-ever
World Vision partners with the Ministry of Health to inaugurate hand-washing stations in health facilities. (2020, September). Retrieved November 02, 2021, from https://www.wvi.org/stories/rwanda/world-vision-partners-ministry-health-inaugurate-hand-washing-stations-health.