Hygiene refers to the conditions and practices that help maintain health and prevent spread of disease including handwashing, food hygiene, and menstrual hygiene management (see Menstrual Health).
Hygiene has long-established links with public health, but was not included in any MDG targets or indicators. The explicit reference to hygiene in the text of SDG target 6.2 represents increasing recognition of the importance of hygiene and its close links with sanitation. Hygiene is multi-faceted and can comprise many behaviours, including handwashing, food hygiene, and menstrual hygiene (see Menstrual Health). International consultations among WASH sector professionals identified handwashing with soap and water as a top priority in all settings, and also as a suitable indicator for national and global monitoring.
The JMP service ladder for hygiene
The presence of a handwashing facility with soap and water on-premises has been identified as the priority indicator for global monitoring of hygiene. Households with a handwashing facility with soap and water available on-premises meet the criteria for a basic hygiene service. Households that have a facility but lack water or soap will be classified as having a limited service, and distinguished from households that have no facility at all (no service). In some cultures, ash, soil, sand, or other materials are used as handwashing agents, but these are less effective than soap and are therefore counted as limited hygiene services.
Availability of a handwashing facility with soap and water at home
Availability of a handwashing facility lacking soap and/or water at home
No handwashing facility on premises
Note: Handwashing facilities may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. Soap includes bar soap, liquid soap, powder detergent, and soapy water but does not include ash, soil, sand or other handwashing agents.
Household surveys increasingly include a section on hygiene practices where the surveyor visits the handwashing facility and observes if water and soap are present. Observation of handwashing materials by surveyors represents a more reliable proxy for handwashing behaviour than asking individuals whether they wash their hands. The small number of cases where households refuse to permit enumerators to observe their facilities are excluded from JMP estimates.
COVID-19 UPDATE: WASH is essential to protecting human health during the COVID-19 outbreak. Hand hygiene, in particular, is one of the most important measures to prevent the spread of diseases, including COVID-19. Functioning handwashing facilities with water and soap are necessary to practice safe hand hygiene but 2.3 billion (3 out of 10) people globally lacked this critical service in their home in 2020.
Ensuring everyone has access to hand hygiene services will be critical to stopping the spread of COVID-19. Additional details and guidance can be read in the WHO/UNICEF interim guidance on WASH for COVID-19 and the UNICEF Hygiene Programming Guidance Note.