African Journal of Public Health and Health Systems | 16 August 2010
A Review of Nudges and Infrastructure for Sustaining Handwashing Stations in Freetown's Public Schools: An African Perspective
K, a, d, i, a, t, u, B, a, n, g, u, r, a
Abstract
Handwashing is a critical public health intervention, but sustaining hygiene infrastructure in resource-limited settings is challenging. In Freetown, Sierra Leone, public schools have been sites for interventions combining physical infrastructure with behavioural ‘nudges’ to promote handwashing. A synthesis of outcomes and lessons is required to guide future strategy. This review analyses evidence on the adoption and long-term maintenance of handwashing stations in Freetown’s public schools following interventions using nudges and infrastructure. It aims to identify key success factors and persistent barriers from an African perspective. A narrative review methodology was employed. Peer-reviewed literature, grey literature, and programme reports focusing on handwashing interventions in Freetown’s public schools were systematically identified and thematically analysed. The review prioritised studies detailing both infrastructural and behavioural components. Initial infrastructure installation increased access, but sustained use depended on concurrent nudges, such as painted footpaths and peer champion programmes. A key theme was the rapid decline in functionality when basic maintenance responsibilities were not clearly assigned. Community ownership and low-cost, locally repairable technology were critical enablers. The sustainability of handwashing stations is inextricably linked to integrating robust, simple infrastructure with contextually relevant behavioural nudges. Interventions neglecting maintenance logistics and local ownership are unlikely to yield long-term benefits. Future interventions should co-design infrastructure and nudges with school communities, explicitly assign low-resource maintenance roles, and use monitoring frameworks that track functionality. Policy should support local manufacturing of spare parts. hand hygiene, behavioural nudges, WASH, schools, sustainability, Sierra Leone, maintenance, public health infrastructure. This review consolidates practical evidence on sustaining handwashing interventions in a resource-constrained urban African setting, offering guidance for integrating infrastructure and behaviour change approaches.