Hands washing with golden hand-rub solution on a map of Africa

Hand Hygiene Heroes: How Local Production Fought Ebola and Can Save Lives Now

Reese Marlowe in Health & Wellness November 2025 • 5 min read.

"Discover the untold story of how Liberia and Guinea built their own hand-rub solution production during the Ebola crisis, and how this model can bolster public health globally."

The 2014-2016 Ebola outbreak in West Africa was more than just a health crisis; it was a harsh reminder of how fragile healthcare systems can be. One of the biggest problems was the lack of basic infection control measures. This gap caused human-to-human transmission to skyrocket, turning a dire situation into a full-blown humanitarian disaster. But amidst the chaos, a beacon of hope emerged: the local production of hand-rub solution in Liberia and Guinea.

In the summer of 2014, the Geneva University Hospitals (HUG) stepped up. They conducted an IPC assessment and, with support from the Swiss Agency for Development and Cooperation and the Humanitarian Aid Unit (SDC/HA), launched a project tailored to local needs. The goal? To build local capacity for producing alcohol-based hand-rub solution (ABHRS) using the World Health Organization (WHO) formula.

This initiative wasn't just about providing a quick fix. It was about laying the groundwork for sustainable change. By training local pharmacists and equipping hospitals with the necessary tools and knowledge, the project aimed to promote safer care and reduce dependence on foreign aid. It was a bold move, and the results were impressive: over 8,000 bottles of hand-rub solution produced, and a newfound sense of empowerment within the local healthcare systems.

From Crisis to Capacity: Building a Local Solution

Hands washing with golden hand-rub solution on a map of Africa

The project kicked off during the peak of the Ebola outbreak in Liberia (Fall 2014) and continued through the recovery period in Guinea (September 2015). Twenty-one pharmacists in Liberia and 22 in Guinea were selected for intensive training. Each participant received a year's worth of laboratory equipment, chemical products, personal-use containers, and bioethanol. This wasn't just a handout; it was an investment in local expertise.

Selecting the right production sites was crucial. The Ministries of Health (MoH) prioritized hospitals with maternity departments, ensuring safer care for mothers and children. They also aimed for a balance between urban and rural facilities, ensuring that the benefits reached all corners of the countries. Each site had to provide a dedicated, secure space with windows for aeration and a sink with running water – basic but essential requirements.

The training itself was a blend of theory and hands-on practice, led by international experts. The curriculum was carefully adapted from previous experiences in sub-Saharan Africa. Here’s what the training covered:

Validation of the WHO formula by the MoH
Registration of the hand-rub solution as a pharmaceutical product
Practical sessions on ABHRS production

Despite the project's success, the road wasn't always smooth. One major challenge was the scarcity of bioethanol in Liberia and Guinea. Since local trade had been disrupted by the epidemic, all necessary materials had to be sourced through the project. Bioethanol, based on WHO recommendations to produce ABHRS, was imported. Looking ahead, the long-term sustainability of ABHRS production hinges on the local government's commitment, creating demand, purchasing materials, and the continuous support of local partners.

A Lasting Legacy

The Ebola outbreak underscored the vital role of hand hygiene in preventing disease transmission. By building local capacity in ABHRS production, Liberia and Guinea not only addressed an immediate crisis but also laid the foundation for stronger, more resilient healthcare systems. The lessons learned from this experience can be applied worldwide, empowering communities to take control of their health and protect themselves from future outbreaks. The project demonstrated that it was feasible to build local capacity in ABHRS production during an emergency and in limited-resource settings when materials and training are provided. Future programs in similar contexts should identify and address the factors of sustainability during the implementation phase and provide regular, long-term technical support.

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This article is based on research published under:

DOI-LINK: 10.1017/s1049023x18000985, Alternate LINK

Title: Building Local Capacity In Hand-Rub Solution Production During The 2014-2016 Ebola Outbreak Disaster: The Case Of Liberia And Guinea

Subject: Emergency Nursing

Journal: Prehospital and Disaster Medicine

Publisher: Cambridge University Press (CUP)

Authors: Frederique A Jacquerioz Bausch, Olivia Heller, Loséni Bengaly, Béatrice Matthey-Khouity, Pascal Bonnabry, Yakaria Touré, Garrison J Kervillain, Elhadj Ibrahima Bah, François Chappuis, Olivier Hagon

Published: 2018-11-05

Everything You Need To Know

Why was local production of hand-rub solution important during the Ebola outbreak in Liberia and Guinea?

During the Ebola outbreak in Liberia and Guinea, the local production of alcohol-based hand-rub solution (ABHRS) became a critical component of infection control. The project, initiated by Geneva University Hospitals (HUG) with support from the Swiss Agency for Development and Cooperation and the Humanitarian Aid Unit (SDC/HA), focused on training local pharmacists to produce ABHRS using the World Health Organization (WHO) formula. This ensured that healthcare workers and the public had access to a vital tool for preventing the spread of the disease.

What were the main obstacles in producing alcohol-based hand-rub solution locally, and how can these be overcome for future sustainability?

The key challenges faced during the local production of alcohol-based hand-rub solution (ABHRS) included the scarcity of bioethanol, a crucial ingredient for ABHRS production. Because the Ebola epidemic disrupted local trade, bioethanol had to be imported. To ensure long-term sustainability, it's vital that local governments commit to purchasing materials, creating demand, and maintaining support from local partners. This also involves validating the World Health Organization (WHO) formula by the Ministries of Health (MoH) and registering the hand-rub solution as a pharmaceutical product.

What did the training program for local pharmacists in Liberia and Guinea involve, and how did it ensure effective production of alcohol-based hand-rub solution?

The training program involved selecting pharmacists in Liberia and Guinea for intensive training, where each participant received laboratory equipment, chemical products, personal-use containers, and bioethanol for a year. The training curriculum, adapted from experiences in sub-Saharan Africa, included validation of the World Health Organization (WHO) formula by the Ministries of Health (MoH), registration of the alcohol-based hand-rub solution (ABHRS) as a pharmaceutical product, and practical sessions on ABHRS production. This hands-on approach ensured that local healthcare professionals were well-equipped to produce and utilize ABHRS effectively.

How were the locations for hand-rub production sites selected, and what impact did this have on the affected communities?

The Ministries of Health (MoH) prioritized hospitals with maternity departments and aimed for a balance between urban and rural facilities when selecting production sites. Each site needed a dedicated, secure space with windows for aeration and a sink with running water. By focusing on these essential facilities, the program ensured safer care for mothers and children and distributed the benefits of local alcohol-based hand-rub solution (ABHRS) production across different areas, helping to combat the spread of Ebola and reinforce infection control practices where they were most needed.

What are the broader lessons and implications of the hand-rub production project in Liberia and Guinea for global public health and future outbreaks?

The success of local alcohol-based hand-rub solution (ABHRS) production in Liberia and Guinea has broad implications for global public health. By demonstrating that it is feasible to build local capacity during emergencies, even in limited-resource settings, the project has set a precedent for empowering communities to take control of their health. Future programs should focus on identifying and addressing factors of sustainability during implementation, and provide regular, long-term technical support to ensure the continued availability of ABHRS and the strengthening of healthcare systems.