IFH CONFERENCE STATEMENT
The 2nd IFH conference held in New Delhi, India was an important meeting that brought together leading researchers, experts, groups and associations that are responsible for generating policy advice on hygiene issues in the developing countries. During the conference, the delegates and speakers agreed to the development of a consensus statement that summarised the key conference conclusions as well as priority actions and areas requiring further research. It is intended that this conference statement will form a basis for concerted action by the involved parties – governmental and non-governmental organisations, academic researchers, corporate groups and the consumer - in addressing the key issues of hygiene in the domestic setting in developing countries.

Background to the conference
Infectious disease remains a serious global threat to health. The most significant proportion of these diseases occurs in developing countries. Prevention of infectious disease through integrated programmes relating to water supply, sanitation, food quality, and community and home hygiene practice are key factors in controlling infectious disease. The rationale for this conference comes from recognition that if the health benefits from public-funded programmes relating to water supply, sanitation, food quality, etc. are to be commensurate with the investment made, they must be better integrated with the promotion of hygiene practice within the community, the home and its immediate surroundings. Promoting hygiene education and developing community-based projects will empower communities and individuals to take responsibility for their health in terms of hygiene in the home and its environment. This is particularly relevant in regions where governmental organisations may be less able to provide a standard of public health that is common in developed countries.

The main objective of this conference was to evaluate the important and interdependent responsibilities of government, non-government and inter-government organisations, and the corporate world, in order to develop and promote home and environmental hygiene in areas of the world where the threat of infectious disease is high and where improved hygiene practices can bring very significant benefits. The conference covered all the main hygiene areas related to the home: water, sanitation, food hygiene, handwashing, and of hygiene practice in the domestic and peri-domestic settings. For each hygiene area, the related issues, solutions and benefits were evaluated and integrated with evaluations of case histories of intervention measures and other community projects.

Conclusions of the conference
The major conclusions from the conference are as follows:

• Infectious disease remains a serious global problem and is a significant factor in determining the health status and economic progress in developing countries
• We need to give more emphasis to initiatives that are preventative rather than curative. The major hygiene-related measures relating to the home are water and food, sanitation, hygiene practice/behaviour and disposal of refuse
• If the health benefits of public-funded community water supply and sanitation programmes are to be commensurate with the investment made they must be integrated with the promotion of hygiene practice within the home and its immediate surroundings
• If infectious disease worldwide is to be contained in a manner which is economically sustainable, it must be a shared responsibility between government, industry, non-government organisations and the public
• If the responsibility is to be shared by the public and community, effective programmes that combine hygiene education with motivation of behaviour change must be developed and promoted
• There is a need to develop effective partnerships to bring about change at the community level. Such partnerships should involve the private sector together with public agencies, including health authorities, urban and rural development authorities and local government bodies
• There is urgent need for further research most particularly to better understand the key routes of transmission of infection in the home in developing countries and the most effective means to bring about behaviour change.

The conference recommends the following specific priority actions:

1. Action to improve compliance with handwashing in the domestic setting, most particularly handwashing after defecation and before eating food. A key aim of these programmes is to reach even the poorest levels of society. Key action points:
   - Education on good handwashing practice
   - Access to a sufficient quantity of water
   - Access to low cost affordable soap
2. Action to ensure microbial quality of water at the point of use in the home with particular reference to safe handling, storage and treatment of water in the domestic setting. Key action points:
   - Provision of affordable containers for safe storage of water in the home
   - Availability of low cost systems for purification of drinking water at the point of use
   - Establishment of local surveillance systems for water quality
3. Action to increase access to safe means of excreta disposal, particularly for those communities where ‘open defecation’ is still widespread. Key action points:
   - Mobilise resources to accelerate sanitation coverage in rural areas and also, where needed, in peri-urban and urban areas
   - Education on the importance and practice of safe excreta disposal
   - The Governments of developing countries, like those on the Indian subcontinent, where the practice of scavenging of human excreta still occurs, must set out an immediate timetable for an active programme to abolish this practice
4. Action to promote greater awareness at a national level of the importance of food as a vehicle for transmission of pathogens in the home
5. Seek opportunities for inter-sectorial collaboration in promoting control of infectious disease transmission with control of air pollution, houseflies and cockroaches, etc.
6. Lobby for the introduction of ‘home hygiene’ into graduate and postgraduate medical, nursing, public health and engineering courses
7. Lobby for the introduction of hygiene as a compulsory component of primary and secondary school education.

Priorities for research into home hygiene
I. Surveillance studies to determine the actual disease burden in the community and home
II. Surveillance of microbiological quality of food and water at the point of entry in the home and at the point of consumption
III. Determine the key routes of transmission of infection in the home in order to define priorities for intervention
IV. Intervention or other studies to quantify the separate and combined impact of hygiene-based interventions on the disease burden in the community and home
V. Studies to evaluate current behaviour patterns in relation to hygiene of food, water, hands, disposal of faeces and waste disposal
VI. Studies to understand what motivates people to adopt particular patterns of hygiene behaviour in the home
VII. Test the effectiveness of new approaches to hygiene promotion and hygiene education.