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 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). In addition, lack of WASH facilities can prevent students from attending school, impose a burden on women, and diminish productivity.
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.”
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.
Awareness raising for the importance of WASH is regularly carried out by various organizations on some special days of the year, as it is easier to obtain media coverage on those days. These United Nations international observance days include: World Water Day (22 March), Global Handwashing Day (15 October), World Toilet Day (26 November).
Neglected tropical diseases
Water, sanitation and hygiene interventions are essential in preventing many neglected tropical diseases (NTDs), for example soil-transmitted helminthiasis. 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.
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
WASH in schools, sometimes called SWASH or WinS, significantly reduces hygiene related disease, increases student attendance and contributes to dignity and gender equality. Despite increasing awareness of the benefits of WinS, almost half of all schools in low-income countries still lack access to water and sanitation facilities. WASH in Schools:
- Provides healthy, safe and secure school environments that can protect children from health hazards, abuse and exclusion. WinS helps ensure quality education, because children who are healthy and well nourished can fully participate in schooling. Quality education, in turn, leads to better health and nutrition outcomes, especially for girls.
- Encourages children’s pride in their schools and communities by providing dignity and privacy. WinS enables children to become agents of change for improving water, sanitation and hygiene practices in their families and communities.
- Invests in schoolchildren and the health of future generations. WinS helps children realize their full potential now and prepares them for healthy living as adults. Despite the significant benefits of WinS, 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.
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. While the concept is relatively new, there are already examples of group hand washing being incorporated into large scale programs.
Strong cultural taboos around menstruation, which are present in many societies, coupled with a lack of MHM services in schools, results in many girls likely staying away from school during menstruation. Providing female students and staff with practical information and private and safe facilities for MHM contributes to dignity and gender equality and may decrease absenteeism.
The possibility of WASH in Schools being included in the new set of global development goals represents a significant opportunity to raise the profile of WinS.
The strength of the current WASH in Schools evidence base, upon which advocacy and programming are dependent, is varied. While the role of WinS in improving health outcomes and boosting attendance among school children is now more recognized, there remains a need to improve the evidence base around a range of areas, including on the efficacy and effectiveness of WinS programs.
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. 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.
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”. In 2015 750 million people lack access to safe, clean drinking water and approximately 2,300 people die every day from diarrhea. 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 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.
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 employed 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.
- Joint Monitoring Programme for Water Supply and Sanitation
- Waterborne diseases
- Water Supply and Sanitation Collaborative Council
- Sustainable Sanitation Alliance
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