WASH (also spelled WaSH) stands for "Water, Sanitation and Hygiene" - several interrelated public health issues that are of particular interest to international development programs. Affordable access to WASH is a key public health issue, especially in developing countries.
Several international development agencies have identified WASH as an area with significant potential to improve health, life expectancy, student learning, gender equality, and other important issues of international development.
The concept of WASH groups together water, sanitation, and hygiene because the impact of deficiencies in each area overlap strongly. Addressing these deficiencies together can achieve a strong positive impact on public health.
The UN’s Millennium Development Goals included improvement of WASH services in Target 7.C: “Halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation.” They have been replaced by the Sustainable Development Goals where Target 6 includes "Ensure availability and sustainable management of water and sanitation for all".
Access to WASH, in particular safe water, adequate sanitation, and proper hygiene education, can reduce illness and death, and also impact poverty reduction and socio-economic development. Lack of sanitation contributes to approximately 700,000 child deaths every year due to diarrhea, and chronic diarrhea can have a negative effect on child development (both physical and cognitive). In addition, lack of WASH facilities can prevent students from attending school, impose a burden on women, and diminish productivity.
Although access to sanitation has been improving over the past decades, the World Health Organization estimates that still “2.5 billion people – more one third of the global population – live without basic sanitation facilities”. In 2015 750 million people lack access to safe, clean drinking water and approximately 2,300 people die every day from diarrhea.
The United Nation's International Year of Sanitation in 2008 has helped to increase attention for funding of sanitation in WASH programs of many donors. For example, the Bill and Melinda Gates Foundation, has increased their funding levels of sanitation projects since 2009, with a strong focus on reuse of excreta.
Awareness raising for the importance of WASH is regularly carried out by various organizations through their publications and activities on certain special days of the year (United Nations international observance days), namely: World Water Day for water (22 March), World Toilet Day for sanitation (26 November) and Global Handwashing Day for hygiene (15 October).
Neglected tropical diseases
Water, sanitation and hygiene interventions help to prevent many neglected tropical diseases (NTDs), for example soil-transmitted helminthiasis. An integrated approach to NTDs and WASH benefits both sectors and the communities they are aiming to serve. This is especially true in areas that are endemic with more than one NTD.
A map has been created to help identify areas with high levels of infection with the WASH-impacted NTDs and low levels of rural improved water and sanitation coverage. In addition, WASH practitioners can use the manual "WASH and the Neglected Tropical Diseases: A Manual for WASH Implementers" to target, implement, and monitor WASH program impact on the NTDs.
In August 2015 the World Health Organization (WHO) unveiled a global strategy and action plan to integrate WASH with other public health interventions in order to accelerate elimination of NTDs. The plan aims to intensify control or eliminate certain NTDs in specific regions by 2020. It refers to the NTD roadmap milestones that included for example eradication of dracunculiasis by 2015 and of yaws by 2020, elimination of trachoma and lymphatic filariasis as public health problems by 2020, intensified control of dengue, schistosomiasis and soil-transmitted helminthiases. The plan consists of four strategic objectives: Improving awareness of benefits of joint WASH and NTD actions; monitoring WASH and NTD actions to track progress; strengthening evidence of how to deliver effective WASH interventions; and planning, delivering and evaluating WASH and NTD programmes with involvement of all stakeholders. The aim is to use synergies between WASH and NTD programmes.
WASH in schools
More than half of all primary schools in the developing countries with available data do not have adequate water facilities and nearly two thirds lack adequate sanitation. Even where facilities exist, they are often in poor condition. WASH in schools, sometimes called SWASH or WinS, significantly reduces hygiene related disease, increases student attendance and contributes to dignity and gender equality. WASH in Schools contributes to healthy, safe and secure school environments that can protect children from health hazards, abuse and exclusion. It also enables children to become agents of change for improving water, sanitation and hygiene practices in their families and communities.
Supervised daily group handwashing in schools can be an effective strategy for building hygiene habits, with the potential to lead to positive health and education outcomes for children.
Strong cultural taboos around menstruation, which are present in many societies, coupled with a lack of Menstrual Hygiene Management services in schools, results in girls staying away from school during menstruation.
Part of the reason for slow progress in sanitation may be due to the “urbanization of poverty,” as poverty is increasingly concentrated in urban areas. Migration to urban areas, resulting in denser clusters of poverty, poses a challenge for sanitation infrastructures that were not originally designed to serve so many households, if they existed at all.
As poverty becomes more concentrated in urban areas, one increasingly common phenomenon is the expansion of urban slums. Often built illegally in response to a lack of more permanent housing, slums have a specific set of problems associated with them. For instance, the lack of property rights and instability associated with a slum dwelling may mean that the resident would not be willing to invest in WASH services for a building that may not survive a storm, or from which she may be evicted. In addition, “New urban areas may be very heterogeneous—both ethnically and in terms of wealth distribution. They may face a constant influx of new migrants.” Such heterogeneity may make it difficult to coordinate efforts to build and maintain a shared sanitation system for slum neighborhoods.
National WASH plans and monitoring
A WHO report found that only one-third of the countries surveyed have national WASH plans that are being properly implemented, funded and regularly reviewed. In most countries monitoring was inconsistent and there were critical gaps. Reliable data is essential to inform policy decision, to monitoring and evaluate outcomes, and to identify those who do not have access to WASH. Many countries have WASH monitoring frameworks in place, but most of the data reported was inconsistent, weakening evaluation and outcome data analysis.
Failures of WASH systems
National government mapping and monitoring efforts as well as post-project monitoring by NGOs or researchers, have identified the failure of water supply systems (also known as water points, wells, or boreholes) and sanitation systems (one part of sanitation systems are the toilets).
The main obstacle in the use and maintenance of improved water and sanitation systems is not the quality of technology, but the failure "in qualified human resources and in management and organization techniques, including a failure to capture community interest".
The abbreviation WASH was used from the year 1988 onwards as an acronym for the "Water and Sanitation for Health" Project of the United States Agency for International Development. At that time, the letter "H" stood for "health", not "hygiene". Similarly, in Zambia the term WASHE was used in a report in 1987 and stood for "Water Sanitation Health Education". An even older USAID "WASH project report" dates back to as early as 1981.
From about 2001 onwards, international organizations active in the area of water supply and sanitation advocacy, such as the Water Supply and Sanitation Collaborative Council and the International Water and Sanitation Centre (IRC) in the Netherlands began to use "WASH" as an umbrella term for water, sanitation and hygiene. "WASH" has since then been broadly adopted as a handy acronym for water, sanitation and hygiene in the international development context. The term "WatSan" was also used for a while, especially in the emergency response sector such as with IFRC and UNHCR, but has not proven as popular as WASH.
- Waterborne diseases
- Water Supply and Sanitation Collaborative Council
- Sustainable Sanitation Alliance
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