South Africa

South Africa

Approximately 44% of South Africans have access to basic hand hygiene (HH) services. The nominal increase in universal HH, 0.63%, between 2015 and 2020 and South Africa’s score of 1.04 and 1.09 on the HHAFT Tracker and Assessment’s 4-point scale, respectively, can be attributed to several factors: a lack of national targets and financing strategy, fragmentation of roles and responsibilities across ministries and departments, and a limited focus. South Africa has created a National Hand Hygiene Strategy and established a multi-sectoral Hand Hygiene Coordination Committee (HHCC) to ensure a coordinated approach and implementation of the strategy. In addition, it will be imperative that the HHCC works with the Ministry of Health (MoH) to cost the National Hand Hygiene Strategy, develop a financial strategy, and identify funding to resource its implementation.


Prepare for Action1.00
Analyse the Situation / Assess the Need1.75
Prioritise Actions0.60
Execute Plans1.50
Monitor, Evaluate and Course Correct0.50

The National Hand Hygiene Strategy provides a framework for universal HH in South Africa. There is a strong understanding of the need, but the focus of the situational analyses to date has been access and is limited to health care facilities (HCFs) and households. Assessing HH in other settings, like schools and public gathering places, and across a broader number of vulnerable groups, as well as looking at factors like practice and determinants, will be beneficial as South Africa establishes national targets for universal HH and continues to prioritise action and build out a detailed action plan and monitoring and evaluation framework. The biggest barrier to execution is lack of a financing strategy and a government-mandated policy to direct and sustain universal HH work.


Data and Information1.25
Capacity Development1.00

South Africa scores extremely high for governance, The Ministry of Health (MoH) serves as the lead ministry for HH, and a national coordination body with multi-sector representation that is mandated to meet regularly exists. Institutional arrangements at the national and sub-national level have been clearly defined, and lead agencies have been assigned based on priority settings. The absence of national targets, despite having national standards, and the fact that the only vulnerable group addressed in the National HH Strategy is women, are South Africa’s weakest areas of policy and planning.

The fact that the Strategy is not costed and there is no financing strategy limits the potential to achieve universal HH. Financing will also be necessary to address M&E, capacity, and innovation bottlenecks. South Africa’s M&E framework and reporting system will need to be made accessible to all stakeholders, comprehensively integrate JMP definitions and standards, and establish a review process and plan for course correction. Although there is an understanding of capacity development needs and the importance of private sector engagement, there are not clear plans or strategies in place for either at present.