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For other meanings, see Wash (disambiguation).

WASH is an acronym, standing for "Water, Sanitation and Hygiene," a group of interrelated public health issues that are of particular interest to international development programs. Access to WASH is a key public health issue, especially in many countries in Asia and sub-Saharan Africa. Several international development agencies have identified WASH as an area with great potential to improve health, life-expectancy, student learning, gender equality, and many other key issues of development.


Access to safe water, adequate sanitation, and proper hygiene education can reduce illness and death, and also impact poverty reduction and socioeconomic development. Poor 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).[1] In addition, lack of WASH facilities can prevent students from attending school, impose a burden on women, and diminish productivity.[2]

The concept of WASH groups together water, sanitation, and hygiene because the impact of deficiencies in each area overlap strongly, and so need to be addressed together in order to achieve a strong positive impact on public health. The UN’s Millennium Development Goals include 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.”[3] However, historically, sanitation and hygiene have often received considerably less attention and funding than the issue of access to water in most WASH programmes. This has been slowly changing ever since the United Nation's International Year of Sanitation in 2008 put the spotlight on the worldwide sanitation crisis. The activities of new donors in the field of sanitation, like the Bill and Melinda Gates Foundation, with a strong focus on reuse of excreta, have also helped to increase the focus on sanitation.[4]


Although access to sanitation has in general been improving over the past decades, the World Health Organization estimates that even still, “2.5 billion people – more one third of the global population – live without basic sanitation facilities”.[5] 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.[6] 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,”.[7] Such heterogeneity may make it difficult to coordinate efforts to build and maintain a shared sanitation system for slum neighborhoods.

A WHO report found that only one-third of the countries surveyed have national WASH plans that are being fully 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.[8]

Possible approaches[edit]

Researchers at the Overseas Development Institute have promoted the value of political economy analysis to better understand the complexities of specific contexts when attempting to identify appropriate responses to WASH challenges in developing countries.[9] They argue that 'best-practice' models of WASH service provision are unlikely to work when applied to real-world contexts. According to the researchers, political economy analysis can help to identify 'best fit' solutions that take into account existing institutions, policies and incentives and so stand a better chance of succeeding.


Neglected tropical diseases[edit]

Water, sanitation and hygiene interventions are essential in preventing many neglected tropical diseases (NTDs), for example soil-transmitted helminthiasis.[10] A holistic and integrated approach to NTDs and WASH efforts will benefit both sectors along with the communities they are aiming to serve. This is especially true in areas that are endemic with more than one NTD.[10]


  1. ^ "Water, Sanitation & Hygiene: Strategy Overview". Bill & Melinda Gates Foundation. Retrieved 27 April 2015. 
  2. ^ "Water, Sanitation, and Hygiene: Introduction". UNICEF. UNICEF. Retrieved 27 April 2015. 
  3. ^ "Goal 7: Ensure Environmental Sustainability". United Nations Millennium Development Goals website. Retrieved 27 April 2015. 
  4. ^ Elisabeth von Muench, Dorothee Spuhler, Trevor Surridge, Nelson Ekane, Kim Andersson, Emine Goekce Fidan, Arno Rosemarin (2013) Sustainable Sanitation Alliance members take a closer look at the Bill & Melinda Gates Foundation’s sanitation grants, Sustainable Sanitation Practice Journal, Issue 17, p. 4-10
  5. ^ UN-Water Global Analysis and Assessment of Sanitation and Drinking Water (2014). Investing in Water and Sanitation: Increasing Access, Reducing Inequalities (GLAAS 2014 Report). World Health Organization. p. iv. ISBN 978 92 4 150808 7. Retrieved 30 April 2015. 
  6. ^ Programme, United Nations Human Settlements (2003). Facing the slum challenge : global report on human settlements, 2003 (PDF) (Repr. ed.). London: Earthscan Publications. p. xxvi. ISBN 1-84407-037-9. Retrieved 30 April 2015. 
  7. ^ Duflo, Esther; Galiani, Sebastian; Mobarak, Mushfiq (October 2012). Improving Access to Urban Services for the Poor: Open Issues and a Framework for a Future Research Agenda (PDF). Cambridge, MA: Abdul Latif Jameel Poverty Action Lab. p. 5. Retrieved 30 April 2015. 
  8. ^ "UN reveals major gaps in water and sanitation – especially in rural areas". WHO. Retrieved 19 March 2015. 
  9. ^ Kooy, M. and Harris, D. (2012) Briefing paper: Political economy analysis for water, sanitation and hygiene (WASH) service delivery. Overseas Development Institute
  10. ^ a b Johnston, E. A.; Teague, Jordan; Graham, Jay P. (2015-06-11). "Challenges and opportunities associated with neglected tropical disease and water, sanitation and hygiene intersectoral integration programs". BMC Public Health 15 (1): 547. doi:10.1186/s12889-015-1838-7. ISSN 1471-2458. PMID 26062691. 

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