Slum dwellers still unable to access basic hand hygiene services

Basic hand hygiene remains a challenge to the most vulnerable communities and residents of informal settlements six months since the coronavirus was declared a pandemic.

This, according to the World Health Organisation and United Nations International Children's Fund, poses an immediate risk of Covid-19 infection and eventual spread of the virus.

Hand hygiene has proven to be one of the most effective tools to prevent the spread of the new disease and a range of other infections.

In Nairobi’s informal settlements, hand washing is a challenge and social distancing is almost impossible.

Mass testing in slums like Kibera, Mathare, and Kawangware indicates a spike in Covid-19 positive cases.

While well-wishers and corporates continue to donate hand washing stations, almost all households in those estates lack water and soap for basic hand washing. Residents rely on communal water points.

The WHO and Unicef estimate that two out of three people lack hand washing facilities.

“Many of those who lack access to basic hand washing live in overcrowded, desperately poor conditions. Even before the pandemic, children and families faced barriers to accessing health and hygiene services,” Unicef Executive Director Henrietta Fore and WHO Director-General Tedros Adhanom Ghebreyesus say in their latest joint statement.

Globally, two in five health care facilities do not have hand hygiene at points of care, according to the two UN agencies.

One of the hand washing facilities donated to Kibera to help in the fight against Covid-19
Image: MAGDALINE SAYA

Last year’s national census put the number of households in informal settlements at more than 1.5 million.

Overcrowding, coupled with poor sanitation, makes these areas a health ticking time bomb.

Further, the enforcement of the government's stay at home order cannot work in such areas as residents survive on a daily wage.

The UN agencies said public health response and reopening plans should couple physical distancing and other control measures with hand hygiene and access to safe water and sanitation. These must reach the most vulnerable communities.

“The Covid-19 pandemic has exposed an uncomfortable truth; too many people around the world simply cannot clean their hands. But we can help to reduce the spread, and we can prevent future infectious diseases from following a similar path.

They added: “It starts by making sure everyone, everywhere has access to basic hand hygiene facilities with soap and clean water or alcohol-based products in homes, schools and health care facilities.”

A few weeks ago, the Health ministry launched home-based care guidelines for management of asymptomatic and mild cases at home.

However, Health Director-General Patrick Amoth on Wednesday ruled out the possibility of residents of informal settlements benefiting.

According to the DG, home-based care tends to apply more to those in the middle and upper middle classes because of the nature of the guidelines.

One of the major requirements to be met by a patient to be eligible for home-based care is the capability to adhere to the precautions recommended. These include home-based isolation and care, respiratory hygiene, cough etiquette and hand hygiene.

This cannot be achieved in informal settlements where water is a precious and scarce commodity.

Hand hygiene must be performed after any type of contact with the patient or their immediate environment, before and after preparing food, before eating, after using the toilet, whenever hands are perceived to be unclean and before and after removing gloves and the mask.

Additionally, linen and eating utensils for the patient should be disinfected with 0.5 per cent Chlorine bleach immediately after use. These items should be cleaned with soap and water for them to be re-used.

The patient’s clothes, bed linen, and bath and hand towels should be cleaned using regular laundry soap and water.