Table of Contents
A Cheap Habit, an Expensive Failure
In Bihar, nearly 14 in every 100 children under five had diarrhoea in the two weeks before the national family health survey. That is almost double the national average of 7.3%, and about six times the rate in Lakshadweep. Same country, same decade, very different odds of a healthy childhood.
The reason is not mysterious. Diarrhoea spreads by the faecal-oral route, and unwashed hands are a key link in that chain. Promoting handwashing with soap reduces childhood diarrhoea risk by 30% and acute respiratory infections by 17%. Globally, unsafe water, sanitation and hygiene (WASH) account for around 1,000 child deaths under five every day.
India has made real progress. Between NFHS-4 (2015-16) and NFHS-5 (2019-21), households using improved sanitation rose from 48.5% to 70.2%, handwashing facilities with soap and water from 60% to 78%, and open defecation fell from 39% to 19%. Childhood diarrhoea prevalence fell from 9.2% to 7.3%. NFHS-6 (2023-24) shows improved drinking water at 96.5%, and severe diarrhoea down from 0.7% to 0.5%, a fall the health ministry links to rotavirus vaccination as well as safer water. Hygiene gets a share of the credit, not all of it.
But averages hide the gap. In NFHS-5, 99% of Kerala’s households used an improved sanitation facility, against 49% in Bihar. Toilet access was 69% in Scheduled Tribe households versus 93% in others. Diarrhoea follows the same fault lines: 8.6% among children in poor households versus 5.7% in rich ones (Ghosh et al., 2023). A third of districts (334 of 707) exceeded the national average, and 69 hot-spot districts clustered mostly in Maharashtra, Bihar, Odisha and Gujarat. These are associations, not proof of cause, but they fit the trial evidence. And with drinking water coverage near-universal, one national analysis found that sanitation, not water source, explained the differences in child diarrhoea.
The costs go beyond the illness. Handwashing cuts school absenteeism from gastrointestinal illness by 29-57% (Wang et al., 2017), and by preventing infection it reduces the antibiotic use that drives antimicrobial resistance.
Corporate and community partners have helped. At the Maha Kumbh, Dettol Banega Swasth India planned hygiene training and products for nearly 15,000 sanitation workers and soap at food-serving areas. In schools, Havells and Banka BioLoo installed handwashing stations in over 350, and HDFC Bank’s CSR programme reached more than 850 government schools. A Rotary club and the Naini Group committed to funding sanitation staff salaries for three years, which matters because a handwashing station nobody maintains is a monument, not a service.
But CSR does the most good when it follows the epidemiology. The district analysis behind these numbers recommends targeting hot-spot districts, which means putting money where the burden is, not where the camera is. And durable change needs government systems. When WHO and UNICEF released their first community hand hygiene guidelines on Global Handwashing Day 2025, they framed hand hygiene as a public good and a government responsibility.
FAQs
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