Hand hygiene is recognised as an effective public health measure for preventing infectious diseases. Sustained practice depends on an enabling environment composed of access to hand hygiene products and services, clear and effective policy provisions, dedicated financing, monitoring and evaluation, and inter-sectoral coordination. The paper examines how Kenya's policy landscape supports or constrains these elements.
The study aimed to map Kenya's national hand hygiene policy landscape and identify governance barriers and systemic opportunities for strengthening policy and practice. The analysis was guided by the Health Policy Triangle (HPT) framework, which systematically examines four domains: context, content, process, and actors. Using HPT allowed the authors to situate policy provisions within Kenya's wider governance arrangements and to identify structural obstacles to implementation.
Primary data were collected through Key Informant Interviews (KIIs) with 11 strategic stakeholders engaged in policy development, implementation, regulation, and programme delivery related to hand hygiene. Secondary data comprised a comprehensive review of 20 policy instruments, which included national policies, strategies, protocols, roadmaps, and binding legal documents. The combined approach was intended to capture both the written policy environment and stakeholder perspectives on governance and operational realities.
In Kenya, formal policy formulation occurs at the national level while implementation responsibilities are devolved to County governments. Implementation is supported by a mix of state and non-state actors. This national-to-County institutional arrangement shapes how hand hygiene provisions are operationalised and monitored across different settings.
The review showed that Kenya does not have a standalone, dedicated national hand hygiene policy document. Instead, hand hygiene provisions exist across multiple policy instruments that address specific settings such as rural areas, schools, and health facilities. This pattern reflects a fragmented policy presence rather than a total absence of policy attention to hand hygiene.
Stakeholder interviews and the document review identified several governance-related barriers that hinder effective implementation of hand hygiene provisions:
Weak inter-sectoral coordinating mechanisms that limit harmonised planning and action across health, education, water, sanitation, and other relevant sectors.
Inadequate financing, including lack of dedicated and sustainable funding streams for hand hygiene activities and infrastructure.
A lack of standardized data and indicators for hand hygiene monitoring, undermining evidence-informed planning and accountability.
These gaps produce governance and operational fragmentation that threaten the sustainability of hand hygiene interventions at national and County levels.
Based on the analysis, the authors propose several systemic reforms to transition Kenya toward an enabling hand hygiene environment:
Establish explicit national hand hygiene standards that provide clear definitions and minimum requirements for provision and practice across settings.
Secure dedicated and sustainable financing mechanisms to fund hand hygiene commodities, infrastructure, and programming.
Strengthen coordination between national and County governments to align policy formulation, resource allocation, and implementation responsibilities.
Integrate standardized hand hygiene indicators into national and sub-national health information systems to enable monitoring, evaluation, and accountability.
These measures are intended to foster more coherent governance, evidence-informed planning, and accountability for hand hygiene implementation.
A clearer policy framework—anchored by national standards and measurable indicators—would enable consistent monitoring and support investment cases for sustainable financing. Improved national–County coordination and stronger inter-sectoral mechanisms would reduce operational fragmentation and better align actors involved in water, sanitation, health service delivery, and education. Collectively, these reforms would contribute to more sustainable hand hygiene practice and service provision.
The article reports findings from a synthesis of 11 KIIs and a review of 20 policy instruments. The paper focuses on mapping the policy landscape and identifying governance challenges and opportunities; it does not, in the abstract, report empirical measures of hand hygiene coverage or intervention outcomes. Detailed methodological and contextual specifics beyond what is summarized here were reported in the full text.
Kenya’s hand hygiene policy environment contains relevant provisions dispersed across multiple documents but lacks a standalone national policy. Governance barriers—weak coordination, insufficient financing, and limited data—create fragmentation that undermines sustainability. The authors recommend establishing national hand hygiene standards, securing dedicated financing, strengthening national–County coordination, and integrating standardized indicators into health information systems to enable coherent governance and accountability.