In the wake of the COVID-19 pandemic, the global spotlight on hygiene practices intensified, unveiling both the power and the fragility of public health interventions aimed at disease control. For a fleeting moment, clean hands, disinfected surfaces, and personal protective habits were heralded as frontline defenses against a microscopic enemy wreaking havoc worldwide. Yet, as the pandemic’s immediate emergency waned, so too did the urgency and momentum behind sustained hygiene improvements, particularly in low-income settings where infectious diseases remain a persistent threat. This paradox—where heightened awareness does not translate into enduring change—raises a fundamental question: how can we reshape hygiene interventions to become more effective, scalable, and resilient in the long term?
To tackle this conundrum, a collective of experts from diverse sectors including health, education, agriculture, academia, policy, and on-ground practice convened recently in Dakar, Senegal. Their mission: to critically analyze the barriers that impede successful hygiene interventions and to identify opportunities for embedding systems thinking into the promotion of hygiene in contexts fraught with high transmission risks. This multidisciplinary and cross-sectoral dialogue reflects a shift away from narrowly targeted behavior change strategies towards embracing ‘hygienic systems’—complex frameworks that encompass the full spectrum of hygiene-related behaviors at critical moments of pathogen exposure, alongside the social, institutional, and infrastructural conditions enabling or constraining these behaviors.
This systemic lens recognizes that hygiene is not merely a collection of individual actions but a multifaceted phenomenon embedded within broader societal and environmental infrastructures. For instance, handwashing with soap, often touted as a simple yet effective preventive measure, is contingent upon reliable access to water and hygiene materials, sociocultural acceptance, supportive policy, and educational reinforcement. Without attending to these interconnected factors, interventions risk faltering once initial enthusiasm or funding dissipates.
One of the pressing challenges illuminated in the Dakar convening is the siloed nature of governance and program implementation. Ministries of health, education, water and sanitation, and agriculture frequently operate in isolation, each with distinct mandates, resources, and priorities. This fragmentation stymies the formation of cohesive strategies that address hygiene holistically. Bridging these institutional divides demands deliberate coordination mechanisms and shared accountability frameworks. Furthermore, transdisciplinary collaboration is essential—not only to integrate technical expertise but also to harmonize on-the-ground realities with policy objectives.
A key theme emerging from this discourse is the imperative to generate and leverage context-relevant evidence. Often, hygiene promotion is informed by generalized models that overlook local nuances such as cultural practices, economic constraints, or ecological conditions. Cultivating robust data ecosystems that capture real-time behavior patterns, infrastructure functionality, and health outcomes can enable policymakers to tailor interventions more precisely and to iterate adaptively.
Closely tied to evidence generation is the localization of guidance. International standards and recommendations must be translated into actionable, culturally congruent strategies that resonate with communities and empower local stakeholders. This localization involves not only linguistic adaptation but embedding local knowledge, beliefs, and social dynamics into program design. Doing so enhances acceptability and sustainability, fostering a sense of ownership rather than external imposition.
Moreover, the concept of ‘hygienic systems’ underscores the multiplicity of critical hygiene moments—not just handwashing but safe food handling, sanitation practices, menstrual hygiene management, and environmental cleanliness. Each of these moments entails specific behaviors and exposure risks that require specialized attention and resources. Addressing all relevant hygiene points comprehensively mitigates transmission pathways more effectively than piecemeal interventions.
The convened experts emphasized that achieving catalytic improvements necessitates moving beyond behavior change at the individual level to transforming enabling conditions at systemic levels. This includes investing in infrastructure that ensures equitable access to clean water and hygiene products, strengthening supply chains, enhancing social protection mechanisms, and fostering inclusive education curricula. Such systemic shifts create environments where hygienic behaviors can be practiced consistently and sustainably.
Technological innovations also feature prominently within this integrated framework. Emerging solutions such as sensor-enabled handwashing stations, data-driven monitoring platforms, and digital behavior change tools hold promise for augmenting traditional interventions. However, their deployment must be guided by systems thinking to avoid unintended consequences like exacerbating inequities or dependency on external technologies without local capacity building.
The intersection of hygiene with broader development agendas—such as nutrition, gender equality, and climate resilience—further highlights the necessity of integrated approaches. For example, clean water and sanitation facilities enable not only disease prevention but also school attendance, maternal health, and economic productivity. Recognizing these interdependencies encourages resource optimization and policy coherence across sectors.
One significant insight from the Dakar discussions was the critical role of policy environments in shaping hygiene outcomes. Regulatory frameworks, financing mechanisms, and political will directly influence the prioritization and resourcing of hygiene interventions. Advocates must engage policymakers with compelling evidence and narratives that illustrate hygiene’s indispensable role in safeguarding health and fostering sustainable development.
Translating systems thinking into practice entails methodological innovation in research and evaluation. Traditional randomized controlled trials focusing on individual-level outcomes may fall short in capturing complex system dynamics. Instead, mixed-method approaches, participatory action research, and system dynamics modeling offer richer insights into feedback loops, emergent behaviors, and contextual variables influencing hygiene ecosystems.
Finally, the pathway toward sustainable hygiene improvements requires nurturing a culture of learning and adaptation. Interventions must embed mechanisms for continuous monitoring, stakeholder feedback, and iterative refinement. Such adaptive management enhances responsiveness to shifting conditions, whether epidemiological trends, climate variability, or sociopolitical changes.
In sum, the quest for enduring hygiene enhancement in settings with high infectious disease burdens demands a paradigm shift—from isolated, behavior-centric programs to integrated, system-oriented strategies. By dismantling sectoral silos, localizing evidence and guidance, and fostering systemic enablers, we can build resilient hygienic systems that not only curb disease transmission but also uplift well-being and equity. This holistic vision is essential if the fleeting gains witnessed during the COVID-19 pandemic are to crystallize into sustained progress.
As this new approach gains traction, it redefines hygiene not as a static checklist of actions but as a dynamic, interconnected system embedded within societal structures. The challenge ahead lies in operationalizing this complexity into practical, scalable interventions that empower communities worldwide to live healthier lives, protected by hygienic environments that reflect collective commitment and collaboration.
Subject of Research: Systems approaches to hygiene interventions for infectious disease transmission control in low-income and high-risk settings.
Article Title: Systems thinking for hygiene in settings with high risk of infectious disease transmission.
Article References:
Freeman, M.C., Crocker, J., Chipungu, J. et al. Systems thinking for hygiene in settings with high risk of infectious disease transmission. Nat Water (2025). https://doi.org/10.1038/s44221-025-00424-9
Image Credits: AI Generated
