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SOAPBOX The Public-Private Partnership for Handwashing Newsletter

December 2008

FOCUS ON… First ever Global Handwashing Day celebrated worldwide Global Handwashing Day was celebrated on October 15 in more than 70 countries across five continents. This inaugural event focused on children and schools. Under the theme “Clean hands save lives”, playgrounds and classrooms, local communities and big cities held high profile, awareness-raising, and educational activities to accelerate handwashing behavior change on a scale never seen before.

In Indonesia, Global Handwashing Day’s logo hit the scene on October 15, reminding governments, teachers, caregivers, mothers and children worldwide that “Clean hands save lives”.

The initiative, driven by the Public-Private Partnership for Handwashing (PPPHW), succeeded in mobilizing and motivating millions around the world to wash their hands with soap, a feat that marks a landmark in hygiene history.

“The Public-Private Partnership for Handwashing is excited to be a part of this important event,” says Nat Paynter, global coordinator of the PPPHW Secretariat. “The world has come together today to recognize the health potential of proper handwashing behaviors. We look forward to

continue promoting handwashing with soap, not only on this annual day, but every day of the year.”

In Peru, children, government and municipal authorities, teachers and parents in four regions - Amazonas, Lambayeque, Ica and Cusco – organized various activities, such as children’s parades and handwashing activities in open spaces, in a joint effort to raise awareness about the importance of handwashing with soap for children’s health. In Colombia, the Minister of Environment, Housing and Territorial Development - Mr. Juan Lozano - joined Global Handwashing Day celebrations with more than 7,000 children in the province of Soacha, Cundinamarca. The event was also attended by 1,000 adults, including parents and local leaders.

Colombia’s Minister of Environment, Housing and Territorial Development, Mr. Juan Lozano, joined Global Handwashing Day celebrations with children in the province of Soacha. In Senegal, the official ceremony brought together the Minister of Health, Dr. Safiatou Thiam, and representatives of both the Ministry of Education and Dakar’s city council. The national Handwashing Team took advantage of this global celebration to pretest a game that enables kids to memorize the critical junctures and get a practical sense of handwashing behavior.

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SOAPBOX NEWSLETTER DECEMBER 2008

In Ghana, the day was launched by the Minister of State for Water Resources, Works and Housing, Ms Cecilia Abena Dapaah, who had the chance to see children perform a series of plays underscoring the importance of proper handwashing with soap. Also, two radio talk shows turned handwashing into their main topic of discussion, with children calling from their homes to raise questions on the issue.

In Bangladesh, over 15 million children in 75,000 schools washed hands with soap on Global Handwashing Day, including a successful event in Dhaka that earned the national handwashing initiative a place in the Guinness Book of Records.

In Kenya, different handwashing activities were launched with the support of the Minister for Public Health and Sanitation, Ms. Beth Mugo, gathering over 6,000 children in Kisumu Town and over 230,000 nationwide.

A record moment: greatest number of children washing hands at the same time in Dhaka (Bangladesh). The achievement was officially certified by the Guinness Book of Records. In India, the support of the famous cricket player, Sachin Tendulkar, helped give the event a huge impact nationwide. Also, in Australia the music band The Wiggles –as UNICEF ambassadors- endorsed the cause by composing and performing in Sydney the catchy song: “Wash your hands with soap and water”.

Kenya’s Minister for Public Health and Sanitation, Ms. Beth Mugo, flags Global Handwashing Day celebrations in Kisumu Town. In Tanzania, the day was celebrated with media briefings and school activations. Over 2,000 pupils from five primary schools participated in the handwashing exercise and demonstrations.

Global Handwashing Day attracted the attention of media outlets worldwide, and was covered by BBC, The Times of India, Nairobi Star and Kathmandu Post, among many other outlets.

In Indonesia, around one million people washed hands and sang handwashing songs in a series of events supported by the national handwashing core group and NGOs in different areas of the country. In addition to mothers and kids, journalists were a key target in these activities. The day became the trigger for a media competition that targets professionals in print, electronic, audio and audiovisual media covering Indonesia. The winners will receive a certificate and a fully-paid trip to a relevant international Handwashing forum in 2009.

The PPPHW is extremely grateful to all countries, public and private partners and organizations who made the inaugural Global Handwashing Day a great success. Their hard work and commitment have helped set the foundations for an annual event in this joint and global effort to reduce children’s death rates through the simple act of washing hands with soap. For more information on Global Handwashing Day, visit: www.globalhandwashingday.org

In Vietnam, over 350 schools participated in HW events including 175,000 children washing hands with soap.

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UPDATES FROM THE COUNTRY

PROGRAMS AFRICA UPDATE

Benin Communicating Handwashing The Handwashing program in Benin is currently undertaking the initial studies that will form the basis of the upcoming countrywide communication campaign. Partners and expected outputs The program is developed by a national coordination established and empowered by WSP-AF under the supervision of the Hygiene Division (DHAB) of Benin Ministry of Health. The main outputs of this partnership – also supported by Unilever and The London School of Hygiene and Tropical Medicine - will include: a business plan, technical assistance in the preparation of basic studies, a baseline and formative research studies, a market study on soap and the establishment of a Handwashing Task Force. Contributed by Joël Ahofodji, Handwashing Coordinator, Benin. Ghana Handwashing on TV A TV program for children was broadcast from April to July on national TV primetime on Saturdays. The 13-week program was produced in the form of an interactive TV Magazine for kids, and its episodes were based on the general syllabus for School Health Education Program. Handwashing issues were integrated into all the topics. The program, called Handwash TV, encompassed different sections, such as; quiz competitions, drama, discussions, and public interviews. According to Michael Forson, Water and Sanitation Specialist, UNICEF, “Handwash TV is a very educative and interesting program. It became one

of the favorite TV programmes for kids and it generated discussions both among children and adults.” Education and training In 4 Ghanaian regions, quiz competitions on hygiene and sanitation were held in schools, with topics that included handwashing with soap.

Also, there are ongoing training sessions on handwashing with soap for district school health coordinators, district training officers and other stakeholders like district water and sanitation teams, environmental health assistants and community health nurses. At the community level, community-based volunteers have been trained for sensitization on handwashing with soap. The main focus is now on turning the increased awareness into sustained behavioral change. Almost all activities make use of interpersonal communication approaches to promote handwashing with soap. Reaching out to the media An orientation course on handwashing with soap for media representatives was held in August as part of the sensitization of the press – an activity aimed at reinforcing the fundamental right to inform on hygiene and sanitation activities. Contributed by Theodora Adomako – Adjei, PPPHW Coordinator in Ghana. Kenya Program for Internally Displaced Persons During and after the post-election violence experienced in Kenya in January 2008, the country had over 350,000 internally displaced people (IDP) living in several camps around the country. They faced a range of problems including exposure to infectious diseases and poor sanitation. Handwashing is one way of preventing infectious diseases and the purpose of this initiative was to communicate the importance of handwashing with soap to people in the IDP camps.

SOAPBOX NEWSLETTER DECEMBER 2008

WSP initiated a process involving various stakeholders (Ministry of Public Health and Sanitation, Kenya Red Cross, Ministry of Water, and UNICEF, among others) to develop hygiene promotion materials for internally displaced persons in Kenya. National Campaign, Regional Synergies The Kenyan Handwashing Team organized pre-tests of concepts developed - and found appropriate - in previous workshops in Kenya, Uganda and Tanzania. The results are being used to design a national communication campaign. National baseline study A national handwashing with soap baseline and a consumer study was commissioned by the Ministry of Health with support from WSP in April 2007. The study results have been reviewed and disseminated to key stakeholders. The report has been edited and will be published early next year.

Contributed by Rufus Eshuchi, PPPHW Coordinator in Kenya.

Senegal Steps forward – and upward The first handwashing initiative run through the PPPHW was piloted in four provinces during 2008. Furthermore, the Scaling Up behavior change project will be implemented in 80 localities across eight provinces. An Impact Evaluation study will be undertaken in these localities. An additional formative research has been launched and its results are expected in end of December 2008. Aiming at mothers and caregivers Around 1.5 million women, caregivers and kids will be exposed to the handwashing messages supported by the partnership. The communication strategy includes interpersonal communication, direct consumer contact (through road shows) and media. Another activity targeting women and caregivers was organized in the suburb of Dakar in presence of local authorities. Handwashing messages were conveyed through cultural activities through the “charm and art” of traditional dancers, wrestlers and theater plays. The messages conveyed were well

accepted by attendees. These tools and videos will be shared through the learning platform shortly. Growing team, growing advocacy The handwashing team has been expanded recently with the hire of short-term consultants for operations, studies and monitoring and evaluation programs. In terms of institutionalization, the partnership is working with the Ministry of Health to ensure that the handwashing program is given full support. The Ministry is also expected to sign a bylaw which will help set up the national steering committee. Contributed by Seydou Koita, Handwashing Task Manager, WSP, Senegal Tanzania Policy Environment for Hygiene The Ministry of Health and Social Welfare is working with WSP to develop a national hygiene and sanitation policy. This process involves key government and non-government stakeholders, such as UNICEF, WaterAid, GTZ, and the National Environmental Management Council (NEMC). The new policy will build on the past success registered in the country especially the ‘Man is health campaign’, implemented in the 1970s, which elevated hygiene and sanitation in the country and built foundations on which the current efforts are riding on. The new policy empowers the local authorities to lead all implementation while the central government and stakeholders focus on the strategic direction, including resources mobilizations for scaling up hygiene activities. In addition, financial resources from the national government’s WSS SWAP have been earmarked for hygiene and sanitation at the local government level. The Ministry of Water and Irrigation has agreed to a dedicated budget line on hygiene and sanitation and will be allocating funds to each district for hygiene promotion.

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SOAPBOX NEWSLETTER DECEMBER 2008

Empowering districts to roll out handwashing activities A two-day workshop was held in Mwanza in November to help district team update their plans on hygiene, sanitation and handwashing. Guided by representatives from WSP and the Ministries for Health, Water, and Education, the sanitation and hygiene leaders of the involved districts had an opportunity to share successes and experiences and deliberate on the strategies to address the challenges they are facing. Organizations like UNICEF, WaterAid, WASH, and Plan were invited and participated in this workshop. The latter shared their experiences in the implementation of a community intervention to improve sanitation and personal hygiene. 1st Hygiene and Sanitation Week and 4th World Toilet Day Celebrations The Ministry of Health and Social Welfare launched the first Tanzanian Hygiene and Sanitation Week. During November 13-14, a number of activities across the country aimed at creating awareness and interest about improved sanitation and hygiene, especially handwashing with soap. Also, a special message delivered in Dar emphasized the government’s commitment to achieve national sanitation and hygiene goals as stipulated in the national strategy for growth and poverty reduction. In Mwanza - where the national events were held – activities included road shows, school events and clinic shows, which paved the way for World Toilet Day climax on November 19. An essay competition among schools took place, and the winning students were awarded with prizes.

School children deliver handwashing messages through a choir performance during the climax of the national hygiene and sanitation week in Mwanza, Tanzania.

The regional commissioner for Mwanza, Dr. James Msekela, read the main message on behalf of the Minister for Health and Social Welfare. The director of preventive services and several senior officers from the Ministries of Water, Education, and Local Government attended and reiterated their commitment to raising sanitation profile in the country. Over 5,000 people attended the event, which was widely covered by local, regional, and national media. Contributed by Abdul Razak Badru, Handwashing Task Manager, WSP, Tanzania. Uganda Fruitful advocacy A national advocacy effort has reached 78 out of 80 districts in the country. The outcome includes the integration of handwashing promotion in district and NGO work plans and an enhancement of the profile of handwashing, which was featured strongly in both the WSS and health annual Joint sector reviews this year. These efforts are helping change the perception of handwashing.

Also, some districts and NGOs have allocated funds for the promotion of handwashing. A small step in the right direction.

‘Hands to be proud of’ has emerged as the promotional campaign catchphrase and it is resonating strongly among Women in East Africa. The concept is being used in Kenya, Tanzania, and Uganda to develop a communication campaign for the national roll outs. Across the East Africa region, all handwashing-related communications, educational and direct consumer activations will be run under the hands-to-be-proud-of platform.

Grassroot mobilization With the help of Dr. Yolande Coomes, the Uganda Handwashing Team is completing a training manual for grassroot mobilization for handwashing. This has a possibility to help other countries in the region and, hopefully, the global fraternity. Contributed by Chris Nsubuga-Mugga, Handwashing Coordinator, WSP, Uganda.

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SOAPBOX NEWSLETTER DECEMBER 2008

ASIA UPDATE Indonesia Handwashing with soap: a key pillar In September 2008 the Minister of Health signed a decree on Community-Led Total Sanitation, where handwashing with soap is considered a major health pillar. This secures the program in Government’s agenda and enables scaling up the campaign in the entire country. Three main documents supporting this regulation have been developed with the support of PPP-HWWS: General Guidelines for handwashing with soap management, Technical Guidelines for Co-Branding Campaign, and Handwashing Stations Options Catalogue. Also, the “Train the Trainer” document includes sections on Partnership and Behavioral change promotion. A time of achievements Some major handwashing events took place in the second half of 2008, starting with a record-breaking moment involving 12,000 people washing hands simultaneously. The Bird Flu campaign was launched on August 24, led by Muhammadiyah – the largest NGO in Indonesia. A morning walk from the National Monument to the headquarters of this NGO marked the campaign, which was conducted in nine cities and supported by USAID, WSP, Unilever, and Reckitt Benckiser. In Safe Hands Expo and Workshop A forum on the role of marketing techniques in handwashing campaigns was created by the Indonesian partnership for handwashing with the support of the Unilever Academy. On November 3, the Safe Hands Expo was attended by high level Government dignitaries and it was followed by a 3 ½ day workshop to develop non-branded Communication Pack for a handwashing campaign in Indonesia.

Handwashing with soap messages in Hajj Embarkations The Hajj pilgrim season takes place in November and December. The Ministry of Health and District Health offices staff helped distribute posters and stickers on the 5 critical times of handwashing, which are being displayed in dining halls, toilets and kitchens. Upcoming event: Mother Day On December 22, PPPHW and its partners will conduct a one-day workshop about mothers in family and business. Participants will include women organizations, associations of small scale restaurants and snacks producers. The workshop will be inaugurated by an inspiring leading woman in Indonesia. Contributed by Ida Rafiqah, Handwashing Coordinator, WSP, Indonesia Vietnam Communication efforts Communications materials were completed in May after some rounds of creative development, pretesting and revisions. The launch of the handwashing National Program took place in June, and was followed by a first burst of mass media aired from July to September on both national and provincial TV stations. ‘Below the Line’ events took place soon after in 10 districts in 8 provinces, with an average of 500 attendees per event. Training sessions A master training course in interpersonal communications to members of the Women’s Union - a leading partner in the PPP for handwashing in Vietnam - was completed in August. Immediately following the master training, the provincial Women’s Union members carried out 260 trainings for community 6,760 HW Champions and IEC Committee Members. In December, the mid-year review will be held, together with a baseline impact evaluation.

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SOAPBOX NEWSLETTER DECEMBER 2008

Upcoming activities March 2009 will see the launch of the handwashing program in schools that will run through the summer and into the fall of next year. Other activities planned for the next months include: meetings with mothers and grandparents, workshops with preschool teachers, household visits, market meetings and provincial launches. Contributed by Nga Kim Nguyen, Handwashing Task Manager, WSP, Vietnam

LATIN AMERICA UPDATE Colombia Throughout 2008, Colgate’s handwashing education efforts in Colombia were aimed at increasing hand washing frequency among children and their families. The strategy of this educational initiative was to generate awareness of the importance in developing consistent handwashing habits by partnering with UNICEF and the Colombian Social Protection Ministry to communicate this message throughout the local community. This successful outreach included grassroots activities and a poster campaign to promote the health benefits of handwashing among the general public. Additionally, an extensive in-store program used informative displays to remind shoppers of the importance of handwashing. In several cities including Bogotá, Medellin and Cali, handwashing stations were featured at shopping malls and sampling was distributed to encourage families to practice good hand washing habits at home. To build good hand washing habits among children, the Clean Hands Good Health campaign was launched throughout Colombia. This program promoted proper handwashing practices among school children with developmentally-appropriate education materials and a classroom curriculum that relayed the fundamentals of hand washing with soap. Contributed by Oscar Caicedo, Marketing Director, Colgate-Palmolive, Colombia

Peru A year of progress This year the handwashing initiative made clear progress in Peru, as it was institutionalized by the Ministries of Health, Education, and Water & Sanitation. Parallel to this, the work made with local authorities at regional, provincial and district level was crucial to promote local ownership. In fact, some local governments have sealed their commitment to the initiative by publishing handwashing decrees in four regions, two provinces and one district.

Local authorities are proving a key partner in Peru. "Schools should promote hygiene and health culture among children", says Ricardo Arone, the Ayacucho Regional Educational Director (left side) accompanied by Edgar Jayo, tutoring specialist. An advocacy strategy was conducted in 21 regions and over 490 professionals were trained during this year. Also, local mass media and handwashing promotional events started in October 2008. The behavioral change program will be implemented in close to 500 districts randomly selected from the 24 regions of the country. Impact Evaluation A survey in 3,600 households - including biometric and anthropometric tests – was completed in August. A report with detailed data and outcomes will be concluded shortly. Learning process Two publications are underway: one on partnership building and another one on the application of the children formative research findings on the design of the communication strategy.

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SOAPBOX NEWSLETTER DECEMBER 2008

Moreover, the blog of the Peru handwashing initiative is proving a useful platform to share experiences on handwashing activities, updates and findings. The blog (written both in Spanish and English) can be visited at: http://handwashing-peru.blogspot.com/ Contributed by Rocío Flórez, Handwashing Task Manager, WSP, Peru NEW PUBLICATIONS & RESEARCH Quezalguaque Hygiene Survey and Pilot Project: A Handwashing Education Intervention in rural Nicaragua. Authors: Denise Burke, Courtney Cawthon, Casey Rebholz, Karen Sherk. The purpose of this research, funded by Colgate Palmolive through an American Public Health Association-administered grant, was to determine if a handwashing promotion program would improve community health in Quezalguaque, Nicaragua. The program, which lasted from June 2007 to January 2008, focused on increasing handwashing with soap at three key times: (1) before food preparation or feeding, (2) after defecation or using the latrine, and (3) after cleaning a child who has defecated among children under six years old and their caretakers. The project occurred in four communities in Quezalguaque; two communities served as the intervention and two communities served as the control. Caregivers in the intervention communities received monthly educational workshops focused on hygiene. Enrolled families in the intervention communities received free soap during biweekly visits from outreach workers. The handwashing education intervention was successful in increasing the knowledge of handwashing among the intervention community. However, no demonstrable health outcomes, such as a decrease in diarrheal and ARI incidence, were shown as a result of the intervention. The increased awareness of disease symptoms and subsequent increase of reporting of these symptoms by the intervention community may have masked any health outcome.

Future efforts to address logistical barriers, such as the location of the soap, protection of the soap, and location of the handwashing water source, may provide a means to change handwashing behavior. This research was made in collaboration with Brookline Sister City Project, Quezalguaque, Nicaragua Ministry of Health and Boston University School of Public Health. Authors may be contacted by email at: [email protected] Handwashing for preventing diarrhea Authors: Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. This review looked at trials of interventions to increase the use of handwashing in institutions in high-income countries and in communities in low- or middle-income countries, and found many of the interventions like educational programs, leaflets, and discussions to be effective. Objectives To evaluate the effects of interventions to promote handwashing on diarrheal episodes in children and adults. Search strategy In May 2007, the team searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE, LILACS, PsycINFO, Science Citation Index and Social Science Citation Index, ERIC, SPECTR, Bibliomap, RoRe, The Grey Literature, and reference lists of articles. We also contacted researchers and organizations in the field. Selection criteria Randomized controlled trials, where the unit of randomization is an institution (e.g., day-care center), household, or community, which compared interventions to promote handwashing or a hygiene promotion that included handwashing with no intervention to promote handwashing. Data collection and analysis Two authors independently assessed trial eligibility and risk of bias. The team stratified the analyses for cluster adjusted and non-adjusted trials. Where

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SOAPBOX NEWSLETTER DECEMBER 2008

appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals. Main results Fourteen randomized controlled trials met the inclusion criteria. Eight trials were institution-based in high-income countries, five were community-based in low or middle-income countries, and one was in a high-risk group (people with AIDS). Considering only trial results that adjusted for cluster randomization, interventions promoting handwashing resulted in a 39% reduction in diarrhea episodes in children in institutions in high-income countries (IRR 0.61, 95% CI 0.40 to 0.92; 2 trials) and a 32% reduction in such episodes in children living in communities in low- or middle-income countries (IRR 0.68%, 95% CI 0.52 to 0.90: 4 trials). Authors’ conclusions Interventions that promote handwashing can reduce diarrhea episodes by about one-third. This significant reduction is comparable to the effect of providing clean water in low-income areas. However, trials with longer follow up and that test different methods of promoting handwashing are needed. Both studies can be downloaded from: http://www.globalhandwashing.org/Global%20activities/Advocacy.htm CAPACITY-BUILDING, OUTREACH, AND ADVOCACY PPPHW Exhibits at APHA Conference The PPPHW exhibited at the 136th American Public Health Association (APHA) Annual Conference and Exhibition, held in San Diego (United States) from October 25-29, 2008. Under the theme Public Health without Borders this year’s conference attracted more than 12,000 attendees, including epidemiologists, international development professionals and health researchers. A fair number of them visited the PPPHW stand, where they were informed about the work of the partnership and its mission to promote handwashing with soap as an effective and

inexpensive way to prevent diarrheal diseases and pneumonia. At the opening ceremony, APHA’s Executive Director, Georges Benjamin, emphasized the importance of collaboration among countries in a globalized world. “From infectious diseases to climate change, today’s public health threats know no boundaries. A decision made in one country today could affect a population halfway across the world.” Also, keynote speaker Sir Michael Marmot, chair of the World Health Organization’s commission on social determinants of health, called for imperative action “to create the conditions for people to lead flourishing lives” and concluded that health equity is an achievable goal. At the conference, some educational sessions revolved around the beneficial effects of handwashing. Dr. Regina Idu Ejemot, from Calabas University in Nigeria, presented a study on “Effects of intervention promoting handwashing for preventing diarrhea” and researcher Courtney Cawthon, from Vanderbilt University Medical Center, shared with attendees her experiences and findings in a handwashing program implemented recently in Nicaragua. (See Soapbox section “Research and publications”.)

Dr. Regina Idu Ejemot (right side) presents on the “Effects of intervention promoting handwashing for preventing diarrhea” - APHA Conference in San Diego, United States.

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SOAPBOX NEWSLETTER DECEMBER 2008

Water and Public Health: the 21st Century Challenge ‘Water and Public Health’ will be the theme of the 2009 American Public Health Association Annual Meeting, to be held in Philadelphia (United States) from November 7-11, 2009. Submission of abstracts will be open from December 19, 2008 to February 9-13, 2009. For more information on how to become a speaker at APHA 2009, visit: http://www.apha.org/meetings/sessions/. IN THE NEWS India’s Prime Minister supports handwashing at SACoSan Conference Manmohan Singh, the Indian Prime Minister, opened the Third South Asia Conference on Sanitation (SACOSAN III) in New Delhi on November 18, 2008. Two thirds of South Asia’s 1.5 billion people lack access to appropriate sanitation, an alarming reality that calls for immediate action. As Mr. Singh said, “[S]anitation is concerned with not just personal health but also human dignity.” In his speech, the Prime Minister called for sanitation to be recognized as the, “birthright of every citizen of South Asia” and pointed out the simple act of washing hands properly as a means to significantly reduce diarrheal diseases. SACoSan III concluded on November 21 with the Delhi Declaration, whereby the heads of delegations of eight South Asian countries – Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka – confirmed their commitment to achieving the Millennium Development Goal (MDG) on sanitation in a time-bound manner in their respective countries.

The joint press release sent out by the participating countries emphasized that, “behavior change communication and information sharing will be effectively utilized for creating demand for a clean and healthy environment, and for promoting good hygiene behavior.” The text also mentions that a, “greater thrust will be placed on promoting adequate sanitation in schools and hygiene education will be incorporated into the school curricula to promote good hygiene behavior and upkeep of facilities.” SACoSan 2010 and 2012 will take place in Sri Lanka and Nepal, respectively. UPCOMING ACTIVITIES The PPPHW’s Steering Committee will meet next in early 2009, in Washington DC.

We encourage and welcome your comments and contributions to SoapBox. Please send them to Eloy Parra at [email protected]

Want to learn more about the global Public-Private Partnership for Handwashing with Soap? Visit

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