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How to Save 1 Million Children a Year
July 25, 2002

"The leader needs to be in touch with the employees and to communicate with them on a daily basis." —Donald Petersen


The following news on hand-washing appeared in the July 6th issue of The Economist (www.economist.com):

"The second-biggest killer of children in the world is neither malaria, nor tuberculosis, nor AIDS. It is the runs. Diarrhoea kills the equivalent of a jumbo-jet full of children every four hours. Development experts have known this for years, and have struggled to prevent it by diverse means: easier access to water for washing, better health education, oral rehydration therapy, and so on. Now, it seems that the best solution may also be the simplest: persuading people to wash their hands with soap.

"....a literature review carried out by Valerie Curtis and her colleagues at the London School of Hygiene and Tropical Medicine finds that appropriate hand-washing can cut diarrhoeal diseases by 43%. It may have an equally big impact on respiratory-tract infections, the biggest child-killer of all. A huge study carried out for the American Army found that sniffles and coughs fell by 45% when troops washed their hands five times a day.

"But how to persuade people to scrub? Two years ago, at a World Bank forum on hygiene and health, Dr. Curtis suggested a global partnership between soap makers and sanitation experts. Development officials had always tended to emphasize the role of the public sector in improving public health. But it is the private sector that builds most of the world's toilets and sells its soap. A previous public-private partnership, involving three big soap companies, had worked well in Central America. Dr. Curtis began with a trial in two places: Ghana in West Africa, and Kerala, a relatively developed state in southern India.

"Bringing together all those concerned with encouraging hand-washing turned out to be a revelation. The private sector soap companies and the government officials found it hard to understand each other at first. The ponderous bureaucracy of officialdom dismayed the soap companies. The bureaucrats mis-judged the difficulty of getting rival companies to work together.

"Now the World Bank is backing a programme in Ghana to promote hand-washing. The Indian and Keralan governments are raising $8-10 million for a similar three-year programme in Kerala. The soap companies think sales could grow by 40% in each market.

"The health experts are bowled over by the marketing prowess that the companies are bringing to the project. Together they have, for instance, understood that Ghanaians prefer liquid to solid soap for hand-washing and are more likely to wash their hands before eating if he soap does not smell too strong (since Ghanaians often eat with their hands). They have also calculated that an ideal time to change a mother's habits is when a new baby arrives (because she is then more receptive to new ideas and also in more frequent contact with health workers). They have learned when and how often to show advertising to have maximum impact. And they have realised that families may want to buy soap in very small quantities because some dislike sharing toilet soap and others cannot afford to buy big bars.

"Once the programme has been rolled out in the first two places, it will be extended to China, Nepal, Peru, parts of Central Asia and Senegal. According to Dr. Curtis, soap is a sort of do-it-yourself vaccine. And profitable and affordable too."

Watch for Dr. Susan Aronson's advice on health and safety in early childhood programs in Child Care Information Exchange. For subscription information go to www.ChildCareExchange.com.


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