Why handwashing habits are fading again

World Health Organisation is hoping to re-ignite momentum through policy and accountability on hand washing behaviour

Kampala, Uganda | PATRICIA AKANKWATSA | In the early days of the COVID-19 pandemic, the message was drilled into public consciousness with rare global unity: wash your hands. From Kampala to Kansas, handwashing stations mushroomed in schools, markets, and hospitals. Posters, jingles, and hashtags evangelised the practice. For a time, the world’s oldest hygiene ritual became a daily ritual for millions. But now, nearly four years after the peak of the crisis, the sense of urgency has dried up—and with it, the habits.

Hand hygiene, long championed by the World Health Organisation (WHO) as one of the most cost-effective tools in the public health arsenal, is once again slipping into neglect. Despite widespread knowledge of its importance in preventing illnesses such as cholera, diarrhoea, influenza and COVID-19, actual compliance has declined sharply. The problem, experts say, is no longer awareness—but behaviour.

“The problem isn’t that people don’t know,” says Tabley Bakyaita, a behavioural scientist and consultant with the United Nations Children’s Fund. “It’s that the knowledge hasn’t translated into a habitual response, especially now that the visible threat of COVID-19 has faded.” At the height of the pandemic, fear served as a powerful behavioural cue. But fear, Bakyaita notes, is a fragile motivator—unsustainable in the long term.

That behavioural insight lies at the heart of a puzzling public health challenge: how to make good habits last once the urgency wanes. According to Prof Freddie Ssengooba of Makerere University’s School of Public Health, the gap between knowledge and action often boils down to logistics. “Washing hands is hard if clean sinks with soap and water aren’t nearby,” he says. In places like informal markets and overburdened schools, handwashing infrastructure is often an afterthought. “If access isn’t easy, people simply won’t do it.”

Crowded demands

Nor is it always top of mind. With daily routines crowded by competing demands, even obvious hygiene cues—like touching a doorknob or handling money—fail to trigger action. “You forget,” says Prof Ssengooba. “It’s not always conscious. And for habits to form, you need consistency and cues.”

During COVID-19, Uganda rolled out some of the most visible and intense public health messaging campaigns in its history. But that momentum has dissipated. “The messages have gone stale,” Prof Ssengooba argues. “What we had during COVID-19 was twenty times stronger than what we have now. And it shows.”

The problem, it seems, is that campaigns are not enough. What is required is a deeper understanding of human behaviour and a more deliberate attempt to nudge people toward hygiene routines—even when the crisis is no longer acute. That means designing spaces, routines, and incentives that make handwashing easy, automatic, and expected.

Need to reset

Bakyaita suggests that the post-pandemic lull is an opportunity to reset the approach. “A major crisis can get people to change temporarily. But to make that change last, you need to understand the deeper, often invisible reasons behind people’s actions—or inactions,” he says.

The WHO is hoping to re-ignite momentum through policy and accountability. On May 5, it marked 17 years of its global “SAVE LIVES: Clean Your Hands” campaign.

The latest push comes with a more structured framework. By 2026, all reference hospitals globally are expected to have systems in place for monitoring and feedback on hand hygiene compliance.

It is a small but significant target in the broader WHO Framework for Action 2024–2030, which also calls for universal access to Water, Sanitation and Hygiene (WASH).

More broadly, WHO is urging countries to institutionalise hand hygiene as a core quality metric in healthcare, with clearly defined techniques and adherence to the “5 Moments for Hand Hygiene” approach.

It also wants infection prevention teams to include dedicated hand hygiene champions to ensure practices are not just taught—but lived.