Mapping policy gaps and governance challenges in Kenya's hand hygiene environment: a health policy triangle analysis.

Hand hygiene is an effective public health measure for preventing infectious diseases. Sustained hand hygiene practice requires an enabling environment that constitutes access to hand hygiene products and services, clear and effective policy provisions, financing, monitoring, and coordination mechanisms. This paper analyses Kenya's national hand hygiene policy landscape and identifies the underlying governance barriers and systemic opportunities for strengthening hand hygiene policy and practice in Kenya. Guided by the Health Policy Triangle (HPT) framework, this study systematically examined the context, content, process, and actors shaping Kenya's hand hygiene policy landscape. Primary data was collected through Key Informant Interviews (KIIs) with 11 strategic stakeholders involved in policy development, implementation, regulation, and programme delivery. Secondary data was through a comprehensive review of 20 policy instruments, including national policies, strategies, protocols, roadmaps, and binding legal documents. In Kenya, policies are formulated at the national level and devolved to the County level for implementation, with support from state and non-state actors. The analysis showed that Kenya lacks a standalone, hand hygiene policy document. However, hand hygiene provisions are present in policy documents which cover hand hygiene in several settings such as rural areas, schools, and health facilities. This reflects fragmented policy presence rather than complete absence. Barriers hindering effective implementation include weak inter-sectoral coordinating mechanisms, inadequate financing, and a lack of data. These gaps create governance and operational fragmentation, undermining the sustainability of hand hygiene interventions. To transition to an enabling environment, Kenya should establish explicit national hand hygiene standards with clear definitions and minimum requirements, secure dedicated, and sustainable financing mechanisms, ensure national-County coordination, and integrate standardized hand hygiene indicators into the national and sub-national health information systems. These reforms will support more coherent governance, evidence-informed planning, and accountability for hand hygiene implementation.