Lessons from the deployment and management of public handwashing stations in response to the COVID-19 pandemic in Kenya: A cross- sectional, observational study
Authors: Muchangi Josphat Martin , Munai Dennis , Moraro Rogers , Thorseth Astrid Hasund , Tupeyia Viola , Muriithi Judy , Lamb Jennifer , Gichuki Richard , Greenland Katie , Simiyu Sheillah 
Published: January 2023

Abstract
Background: At the onset of the pandemic in Kenya, a multisector taskforce was set up to coordinate the COVID-19 response. The taskforce identified 7500 COVID-19 transmissions ‘hotspots’ in public spaces across Kenya, coordinated partners and implemented hand hygiene interventions. To complement these efforts, the National Business Compact Coalition procured and distributed 5311 handwashing stations (HWSs); conducted behavior change communications; and provided technical support on operation, maintenance and monitoring to HWSs caretakers across the country. In view of these interventions, it was paramount to assess the functionality, usability and accessibility of the public HWSs in order to improve the operation and maintenance and inform strategies for future roll-out of HWSs in public settings.
Methods: This was a mixed-methods observational study conducted in five randomly selected counties in Kenya: Nairobi, Kwale, Embu, Mombasa and Homabay. Quantitative data were collected through spot checks of randomly selected HWSs in these counties, caretaker surveys, user observations and user exit interviews. Qualitative data were collected through key informant interviews, focus group discussions and in-depth interviews. Quantitative data were analyzed using Chi-square tests, or where applicable, Fisher’s exact tests to assess the accessibility, usability and functionality of the HWSs. Qualitative data were analysed thematically and used to support the quantitative findings.
Results: A total of 430 HWSs were targeted for this study and 316 (73%) were located and surveyed. The remainder were largely absent because the caretakers were absent or had relocated, or had been stolen, in storage or in the caretakers’ home. Of the located handwashing facilities, 83.9% were functional (meaning the facility had water in it, soap available for use and a functioning tap). A significantly higher proportion of functional handwashing stations were managed by a paid caretaker (95.9%) compared to an unpaid caretaker (78.4%) (P=0.001). Only 35% of HWSs were accessible for a person using a wheelchair, 76.9 accessible for child under 12 years, and 76.3% accessible for older persons, 81.6% of users reported HWSs to be of comfortable height, and about half (49.1%) of the HWSs were set up on uneven and/or muddy ground.
Conclusion: This study has demonstrated distribution of public handwashing facilities can have a limited lifespan. HWSs future distributions should prioritise long-term plans for follow-up with caretakers responsible for operation and maintenance of public handwashing stations to provide support and to sustain accountability. It is also imperative to make HWSs accessible for wheelchair users and those less able to walk. Finally, design considerations should be made for comfortable height, placement in stable surfaces, soap placement and drainage of wastewater.