NNN Statement of commitment to hand hygiene for all

October 2020

More than one billion people are at risk of ill health from neglected tropical diseases (NTDs)—diseases that are largely preventable through clean water, decent toilets and good hygiene. The populations who are at risk from NTDs are often the same groups who also lack access to hygiene services and facilities, and the presence of NTDs is an indicator of the need to improve access to water, sanitation and hygiene (WASH) services.

Interventions for NTDs and handwashing are some of the best and most cost-effective health interventions to improve health. However, the combined power of WASH and NTD treatments and care to improve health outcomes is being undermined by low investment in hygiene facilities and hygiene behaviour change. As a result, 3 billion people continue to lack running water and soap at home for handwashing and other hygiene practices, jeopardizing their health and overall wellbeing.

The COVID-19 pandemic has highlighted the urgency around hygiene and its importance to overall health as well as the sustainable control and elimination of all NTDs, across the continuum of prevention, treatment, care and morbidity management. Members of the NTD NGO Network (NNN) are scaling up engagement with handwashing and hygiene more broadly in response to COVID-19, creating an enabling environment to sustain these critical behaviours beyond the pandemic—especially as entire populations are primed to change their behaviours as never before.

Handwashing is one of many critical behaviours that form part of a comprehensive approach to hygiene behaviour change for NTDs. Many NTDs, such as trachoma, soil-transmitted helminthiasis, schistosomiasis and Guinea worm disease, are preventable through practicing healthy behaviours, such as reducing open defecation, maintaining sanitation facilities, water treatment and food hygiene, and hand and face washing with soap. Other NTDs require WASH access for safe and dignified treatment and care, such as managing complications caused by diseases like lymphatic filariasis, where personal hygiene is necessary to reduce disease severity. Additionally, access to adequate WASH in healthcare facilities is critical to prevent secondary infections when performing NTD-related procedures and surgeries, such as hydrocelectomy for lymphatic filariasis and trichiasis surgery for late-stage trachoma. Gender-sensitive and disability inclusive WASH is vital to addressing negative attitudes, norms and beliefs that may lead people affected by NTDs to experience stigmatization and marginalisation.

The NTD community has been a longstanding ally and partner to the WASH sector. Since 2012, the NNN has championed WASH as a fundamental part of our work—not only in addressing NTDs but also to sustainably address the poverty and exclusion that underpin these diseases. The NNN has developed the BEST Framework that guides its members’ advocacy and programming, established a WASH Working Group and more recently, developed WASH and Health Working Together: A ‘How-To’ Guide for Neglected Tropical Disease Programmes together with the World Health Organization.

The launch of Hand Hygiene for All is an opportunity for the NNN to rejuvenate its commitment to hygiene within our broader partnership with WASH actors in order to:

Political leadership

Support delivery against the cross-cutting indicator in the new WHO 2021-2030 NTD road map (in which all NTD endemic areas must reach universal WASH access by 2030).

Support WHO’s 2015-2020 global strategy on WASH and NTDs—which is being updated in line with the NTD 2030 road map— to ensure this cross-cutting target is met.

Support countries to develop and implement cross-sectoral policies, budgets, and coordination mechanisms at the national and local levels.

Enabling environment

Share experiences and best practices for WASH and NTD coordination through publications and conferences (such as at the annual NNN Conference, ISNTD Connect, UNC Water and Health Conference and World Water Week).

Support the uptake and development of tools for enhancing cross-sector collaboration (such as the WASH and NTDs toolkit) to bridge challenges of cross-sector collaboration such as differences in objectives and priorities, indicators and budgetary and capacity constraints.

Sustainable, inclusive programming at scale

Develop a technical resource on behaviour change.

Work with WHO and other stakeholders to develop a research agenda that investigates the determinants of healthy behavioural practices and approaches to sustaining change.

Share learning on integration of hygiene into health programmes within our community and with other sectors


We urge NTD-endemic countries to:

  • Strengthen data systems in order to use existing data to target WASH interventions to NTD endemic areas.
  • Prioritise WASH investments and interventions in NTD endemic areas.
  • Maximise the impact of existing behaviour change programmes through reinforcing hygiene behaviours for NTDs.

We call on NTD development partners to:

  • Champion gender-sensitive and disability inclusive WASH within NTD programmes, in line with the new WHO led global NTD road map and country NTD and WASH plans, including Hand Hygiene for All road maps.
  • Support efforts to integrate WASH into NTD efforts by funding comprehensive NTD programmes that address behaviour, environment, social inclusion and treatment and care.

We call on WHO to:

  • Seize the opportunity presented by the new WHO 2021-2030 NTD road map and Hand Hygiene for All initiative to drive the step change required to coordinate and scale up action on WASH and NTDs.
  • Promote joint leadership by multiple ministries to drive whole of government, multi sector and multi stakeholder approaches, for example, by supporting countries to link national processes to develop NTD Masterplans and Hand Hygiene for All road maps.