Diarrhea is the second largest disease killer of children globally, causing an estimated 1.5 million deaths annually. Diarrhea kills more children under the age of fivezz than AIDS, TB and Malaria combined. 

The solution: Washing hands with soap! Yes, it’s as simple and straightforward as that. How many of us are actually practicing it?  You should be washing your hands at the critical points of hand washing; after using the bathroom and before eating. Shockingly enough, the rates of hand washing range from just 0 to 34% after these critical points.
It seems odd doesn’t it? That in this day and age, something so preventable and simple as this is still not being followed. To cite another example, we all know that it is important for us to exercise for at least 30 minutes in a day to remain healthy. Yet, the majority of us don’t practice it. Changing health behavior is difficult. While hand washing with soap is simple, working to increase this behavior requires thoughtful, tailored and creative interventions with sustained follow up.

Hand washing with soap is one of the most under funded, under implemented and least known solutions to some of the really big health issues

A school girl demonstrating how to use a ‘Tippy Tap’

While there are several initiatives that have been taken up by the public health community to counter the issue of health and sanitation at large, there is one that caught my attention purely because of its simplicity and subsequent effectiveness; the Tippy Tap. (http://www.tippytap.org/the-tippy-tap). While the concept of a Tippy Tap is not new and was invented in the eighties, Grampari, an NGO based out of Panchgani in partnership with the US Based non profit, the Watershed Management Group (WMG), has taken it to the next level to tackle the issue of hand washing. To understand the model better, I had a word with Sowmya Somnath, an engineer who left the US to work on effective models of water, sanitation and hygiene while transforming behaviors associated with it. A founding member of WMG, she has created a handwashing program at Grampari  with the intent to get the word out and developways to increase this behavior “There are so many facets to development; education, livelihoods, leadership, governance. In order to pursue these avenues work your way out of poverty, the first thing you need is….be healthy.” she says.  “The basic goal of the program is to keep people well so that they can pursue opportunities”.


While it all sounds pretty straight forward, Sowmya deals with some major challenges in this space. One of the bigger challenges that Sowmya faces is with the mere simplicity of the solution ie ‘it’s just hand washing’, thus making the promotion difficult. It’s something that everybody knows about, but still does not get practiced. “Handwashing with soap can cut diarrheal morbidity almost in half.  And yet, it would be easier to promote a vaccination that cuts diarrheal incidents by a smaller percentage than promoting a small thing that your mother already taught you when you were young, that you’re already practicing occasionally but not properly and at the correct time. It’s tougher to work with human nature” says Sawmya. The other challenge is that of awareness on the issue; on how big an impact hand washing could have. “Just telling people to wash their hands because it’s good for them, doesn’t work. People need diverse approaches to feel for the issue, and tailoring and catering to that is a bigger challenge”.
The solution she says, to some of these challenges lies in the sophistication in marketing, which is not always utilized enough in public health . “Being a little slicker with the marketing material might be the key here. Some combination of sexy gimmicks and messaging and unsexy hard work and persistence!.

Sowmya at one of the programs

On enquiring about the scalability of the program, Sowmya says “There are forms and levels of scale. The Tippy Tap costs you almost nothing to build, as it is put together with locally appropriate available materials. We are not interested in building Tippy Taps, but are interested in increasing handwashing behavior through Tippy Taps and other means”. Recollecting an incident that happened recently, she mentioned that they had conducted a hand washing  program in a school with children representing 27 households.  One way program impact is measured is to see if households build tippy taps and use them for a sustained period once the intervention is completed. With a little smile on her face, she said that they had just covered the 26th household where the grandmother came out and explained what the Tippy Tap was and how hands should be washed. “She was teaching her family members from the other village on how to wash hands. She had no idea that we were from the program” says Sowmya. “It’s probably these incremental steps and small successes that is going to get us to scale this issue.”.

Watch this video to understand more about how the tippy-tap works: