Leadership and Access to Safe Water: Key Determinants of Improved Hand washing
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Responsible for the death of over 750,000 children every year, diarrheal diseases stand as the second leading cause of death amongst children under 5 (WHO, 2013). A number of epidemiological studies suggest that the universal practice of hand washing with soap could reduce the risk of severe diarrhea by 48% and the risk of any diarrhea by 47% (Greenland et.al, 2012). In Uganda, Government promotes hand washing with soap through the National hand washing Initiative (NHWI), and by providing funding to local governments under the District Sanitation Conditional Grant (DSCG). At 33.2%, however, the percentage of people with access to hand washing facilities remains significantly below the national target of 50% (SPR, 2015). Most alarmingly, the national average reported above hides marked inequities in the availability of hand washing facilities at local level (Figure 1). Such inequities are further perpetrated by the fact that in spite of the existence of a Memorandum of Understanding between the Ministries of Health, Water, and Education, districts and sub-counties lack clear guidance on their respective roles in the promotion of universal hand washing.