About 115km (71 miles) from Mumbai in western India, in a district council school in Devkhop village, eighth grader Archana Vasant Baswat is proud of her steady attendance. It has helped her focus on studies and score well. Until about a year ago, the 14-year-old frequently suffered from skin infections that caused rashes and itching, and sometimes diarrhoea, causing her to miss school. “I didn’t know how critical soap is for maintaining hygiene. We never used it at home,” Baswat says. Her parents are uneducated and never introduced their three children to soap, and therefore, Baswat and her two siblings would bathe irregularly, and only with water, whenever it was available. Mud or plain water was used for washing hands after defecation. Then a workshop from Sundar India, a programme by Sundara Charitable Trust, changed her perception about hygiene. During a 30-minute session at her school, three young women from Sundar, called “hygiene angels”, role-played the fight between germs and soap, showed the five steps of hand washing and played a video reiterating that soap should be used after eating, touching an infant, using the toilet, playing and travelling. They left each child with a free bar of recycled soap to use, with a promise to come back for a follow-up session to find out whether they used it regularly and how they felt about it. “Soap can be a lifesaver,” says Dr Pravin Rathod, the medical officer at the primary health centre for Devkhop. “It is a simple, inexpensive solution for prevention of many infectious diseases such as worm infestation, diarrheal diseases and skin infections caused by poor hand hygiene.” Four out of five people in the world do not wash their hands with soap after using the toilet, according to a 2014 study published in the European journal Tropical Medicine and International Health . The microbiome explained: how a vast army of gut bacteria regulates body’s functioning Diarrhoea is the second leading cause of death worldwide, and kills more children annually than measles, malaria and Aids together, a 2012 report in the Lancet suggests. According to the World Health Organisation, 1.7 billion children globally suffer from diarrhoeal diseases, and over half a million under the age of five die every year, with 75 per cent of those deaths occurring in developing countries. Studies point to a substantial reduction in neonatal infections, a 42 per cent to 47 per cent drop in diarrhoea, a 16 per cent to 23 per cent drop in acute respiratory infections and a 50 per cent drop in pneumonia cases when hand washing is introduced. In lower-income communities in India, though, access to soap and water is limited, and so are the resources to buy soap for families that earn less than 100 to 150 Indian rupees (US$1.44 to US$2.17) a day. Sundar uses a multipronged approach: helping children learn and practice hand hygiene, and recycling used bars of soap that hotels discard. With their work in four villages in Maharashtra and Goa, Sundar has collected more than 8,000kg (17,636lbs) of soap and turned it into 160,000 recycled bars at their five centres and distributed them to ashram schools – free residential schools in tribal areas – government schools and village communities, since it launched in September 2016. At Sundar’s recycling centre in Kalwa village, near Mumbai, three women from the village work every weekday from 10am to 4.30pm to reprocess the discarded soap they collect every month from 26 Mumbai hotels. It takes them three to four days to turn 25 kilos of soap into nearly 3,000 50-gram Sundar soap bars. I’ve seen a reduction of at least 60 per cent of kids in my outpatient department. Fewer kids are malnourished now Dr Pravin Rathod The bars are sanitised then grated and moulded into bars which are cut into small soap bars. In Devkhop, many parents migrate periodically for work, Rathod says. Children are left alone or sometimes with their grandparents. “With no one to watch over them, they are careless about personal hygiene,” he says. When children start school, they often arrive unwashed in dirty clothes and long nails, says Anuja Arun Save, a primary school teacher in another district council school. Most learn about using a toilet at school. “It takes them some time to pick up, but school is the only place they can learn good hygiene practices,” she says. In the two-plus years that Sundar has worked in the region, Rathod has noticed a difference in the health of the community, especially in children. “I’ve seen a reduction of at least 60 per cent of kids in my outpatient department,” he says. “Fewer kids are malnourished now.” He attributes this improvement in their health to improved hygiene practices.