The Supertowel: Using evidence to drive innovation in humanitarian handwashing interventions

Authors: Sian White, London School of Hygiene and Tropical Medicine and Torben Holm Larsen, Real Relief.

A young Eritrean girl hides behind her mother’s skirt and watches intensely as we show her household how to use the Supertowel. We give her one to try and as she starts to clean her hands and face with it, a smile full of wonder shoots across her face.

She is living in Hitsats camp in Northern Ethiopia with her mother. We are here to gather data for research into the efficacy of an innovative, soapless alternative for handwashing. The little girl and her mother recently fled Eritrea – leaving their life and others in their family behind. They are now living in a shelter with three other adults and another child. This situation is not unique. In Hitsats camp, there are many of these ‘combined households’ – where individual refugees go from being complete strangers to housemates on the day they arrive.

Life in the camp is not easy. Most of the year there are extreme shortages of water and sometimes no supply at all. Resources of all kinds are scarce and valued – including soap. Despite this, there is a strong sense of community in the camp and people are generally content with their circumstances and hopeful for the future. Even though they have lost everything, residents of the camp have gained one thing that they lacked in Eritrea – their freedom.

The Saturday we met the young girl was our fourth day in Hitsats camp. We were well on the way with a field study to access user acceptability and feasibility of Supertowel as an alternative to soap for handwashing. Since arriving, we’d spent the mornings observing people’s hygiene behavior in their homes and then, in the afternoons, we gave Supertowels to selected households for them to try for 10 days. During those 10 days, we visited each of the households twice to understand how they used the Supertowels and whether they found them acceptable.

As an extra element of the field study, we held focus group discussions. Two of these were about user preferences. The participants were presented with different hand cleaning products like bar soaps, liquid soap, alcohol-based gel and the Supertowel; and then asked to rank the products according to statements such as most desirable versus least desirable, and expensive versus cheap. In another discussion, we assessed the kinds of behavior change communication that are needed to help people understand what Supertowel is and how it’s supposed to be used. We did this by asking participants to tell us how they interpreted messages in different pictograms related to the use of Supertowel.

(Photo credit: Torben H. Larsen, Real Relief)

The field study is the second phase of a larger project supported by the Humanitarian Innovation Fund, with funds from the UK government through UKAID. It follows a laboratory study where the comparative efficacy of the Supertowel was assessed against handwashing with water and soap. That first phase proved that Supertowel soaked in water is significantly better than soap and water at reducing bacteria from the pre-contaminated hands of volunteers when tested under the same standardized conditions and showed that it was worth testing in the field.

During the field study, we learned that soap is always going to be important in humanitarian crises but also found that something as valuable as water and soap will get prioritized for tasks like bathing and laundry, and almost never get used for handwashing. Our participants universally liked the Supertowel and felt it empowered them to better manage their hygiene in the face of water scarcity and limited economic resources. The Supertowel seemed to improve handwashing frequency and ease, allowing people to clean their hands at times when they might not otherwise bother, such as when outside the home or during food preparation.

When we visit the young girl’s household on the tenth day of the study, we arrived to find the Supertowel hanging around her neck in its waterproof bag. It was wet – a clear sign it had been recently used. Her mother jokes that her daughter has become a little obsessed with the Supertowel. She tells us that she would never independently go and wash her hands before a meal, but that she is now constantly using the Supertowel and reminding everyone else in the household to do the same.

When we started this research we were a little skeptical. The Supertowel was an exciting and novel concept but we knew it would require a major shift in behaviour and we honestly thought that many people would just not like it. Instead the field testing has been rewarding and surprising. We have been able to see first-hand how people can integrate a novel product into their daily routines. More importantly research like this allows new technologies to be improved and developed by crisis-affected populations so that it can better suit their needs.

Having returned from Ethiopia, we are now preparing the full results from these studies for peer-reviewed publication.

About the authors:

Torben Holm Larsen, Technical Director and co-founder of Real Relief, a private sector company behind products like Supertowel, SafepadTM and NetprotectTM. Torben has been working with developing and supplying innovative products for the humanitarian and development sector for almost 20 years. Starting with Long Lasting Insecticide treated Nets (LLIN) to fight malaria and since a.o. water filters, shelters, reusable sanitary pads and lately Superowel. He is a chemical engineer with almost 30 years of experience within everything from product development, manufacturing, sales and management.

Sian White is a Research Fellow in the department of Disease Control at the London School of Hygiene and Tropical Medicine (LSHTM) and is currently doing her PhD on hygiene behaviour in humanitarian crises. Sian has over a decade of experience working on projects to do with hygiene, behaviour change and public health programming in Australia, Asia, the Pacific, Africa and the Middle East. Sian’s research largely involves participatory qualitative methods to assess behaviour, or process and impact evaluations to assess interventions.