Global landscape of locally produced alcohol-based handrub in health care settings: a scoping review.

Abstract

Reliable access to alcohol-based handrub (ABHR) is essential for hand hygiene and infection prevention, yet many low- and middle-income countries (LMICs) continue to face supply constraints. A 2011 WHO global assessment demonstrated that WHO-recommended ABHR formulations produced locally at low cost, were well accepted by healthcare workers, but also highlighted persistent barriers, including challenges in procuring ingredients and dispensers and in ensuring adequate quality control. This review aimed to provide an updated global synthesis of evidence on local ABHR production in healthcare settings. Following the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically searched Embase, Medline, and CINAHL from inception to 19 March 2025. Two reviewers independently conducted title-abstract screening, full-text screening and data extraction. Primary research articles reporting local ABHR production in healthcare settings in LMICs were eligible for data extraction and descriptive synthesis. Of 2343 articles screened, 31 studies from 19 countries were included (2006-2023). Over half (n = 18, 58%) were conducted during the COVID-19 pandemic; 22 described health-facility production and 9 described factory-level manufacturing. Of the 22 health-facility production studies, 12 (55%) used WHO Formulation 1 (ethanol-based) or modifications thereof. Pharmacists most commonly led production at the health-facility level. Only 6% (two articles) reported the source of alcohol, and less than half evaluated efficacy or organoleptic properties (13 and 12, respectively). Most funded studies relied on high-income-country (HIC) grants (17 of 24, 71%). Local ABHR production remains infrequently reported in the literature, although publications increased during the COVID-19 pandemic. Heavy reliance on short-term, HIC-funded initiatives raises concerns about the long-term scalability and sustainability of local ABHR production in LMICs. Strengthening national regulatory capacity, quality-control laboratories, and sustainable financing is critical to maintain safe ABHR access beyond pandemic contexts, for resilient national supply chains and in-country quality control capacity.