Ottawa Public Health in partnership with health staff from the municipality of KEEA (Komenda, Edina, Eguafo, Abrem) in Ghana engaged in a city-to-city partnership to adapt, implement, and evaluate an evidence-based hand hygiene public health initiative in elementary schools in Ghana. All 4 participating schools gained the necessary resources to carry out proper hand hygiene practice, and hand hygiene practice improved. Furthermore, pupils were more likely to wash hands after using the toilets and teachers were better equipped to be good role models. Providing resources to schools was key to the success of the implementation. This partnership gave health and education workers in Ghana the tools, knowledge, and confidence to implement a simple, evidence-based, hand hygiene program. One other remarkable outcome is that school children were the initiators of a behavior change in their community.