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). 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.
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.
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 "WASH and the Neglected Tropical Diseases: A Manual for WASH Implementers" to target, implement, and monitor WASH program impact on the NTDs.
Some national and local governments monitor water services regularly. One example is the Sistema de Información de Agua y Saneamiento Rural(Rural Water and Sanitation Information System).
For organizations that work on WASH interventions, monitoring means using indicators to measure effectiveness of a development program. Some organizations or research organizations do "post-implementation monitoring", which occurs after the WASH intervention has been completed.
The Water Point Data Exchange (WPDx), launched in 2015, is a global platform for sharing water point data collected by governments, non-profit organizations, researchers, and others.
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”. 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.
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.
Examples of system failures
Failures of water supply 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, boreholes, or wells) and sanitation systems (one part of sanitation systems are the toilets). The following sections provide examples of those failures.
- Global: Data for 126,251 water points across 37 countries that are being monitored with Akvo FLOW show that 20% are not functional, and 10% are functional but have problems.
- India: Of 2500 households in 80 villages across the country, 53% do not receive an acceptable level of service.
- Cambodia: SNV Cambodia found these results after surveying 1008 water points in Chum Kiri District: 12.1% of 672 tubewells were not functional, 5.8% of 13 protected dug wells were not functional, 262 unprotected dug wells, and 1.1% of 94 community ponds were not functional.
- Of 898 wells surveyed, 20% were not operational at the time of a University of North Carolina study.
- According to Ampadu-Boakye and Hebert, "The Atebubu Water System, in the Brong Ahafo Region, served a group of eight urban communities with a total population of 32,000. The system was completely non-functional at the time of our visit—sand filters were overgrown with weeds, standpipes had been shut down, and the chlorinator appeared run down." Because of the failure, "Many residents now obtain water from boreholes installed by the district assembly or by NGOs....However, at the time of our visit some 40% were broken."
- Madagascar: 27% of water systems were not functional on the day of a survey. Out of 186 communities visited, "nearly half of all systems broke down in the previous year, and a third of them were reported not to have been fixed satisfactorily. So, by implication, one sixth of all rural water systems breaks down and are not properly fixed, per year.While half of all systems were reported to be functional for the most recent year, a tenth didn’t work at all; systems worked for an average of nine months per year. Note that the survey sample was of systems that had been built or rehabilitated within the last five years. So, at any one time, around a quarter of the rural population of Madagascar has no safe water."
- Afghanistan: During a WaterAid-IRC-RWSN webinar, Leendert Vijselaar of DACAAR said that 35% of 30,182 water points surveyed were non-functional.
- Ethiopia: A survey of 57 diverse water schemes showed 38.6% were non-functional on the day of the visit.
- Ghana: 21% of 1,509 water points were not functioning on the day of visit.
- Malawi: In a survey of 48 villages, 66% of MALDA handpumps installed one year before the visit were recorded as being non-functional."[T]he proportion of fully functional MALDAs was between 29% and 50% in all age cohorts."
- Nepal: The National Management Information Project shows that of 40,000 gravity flow schemes, 82% are not fully functional. 
- National mapping shows 38% of 74,331 water points are not functional, and 7% are functional but need repair.
- A survey of 43 taps and 4 cattle troughs showed that 11% were not functional on the day of the visit (Welle & Williams, 2014).
- 36% of 45 surveyed community managed well sites were not functional; another 24% were either semi-functional needing minor repairs or minimally functional needing major repairs.
- 16% of rural improved water points were non-functional. 
- In Bundibugyo, 21% of water points are not functional on average. Some subcounties have functionality rates well above 90%, but others like Kanara and Bubandi have functionality rates as low as 33%. These non-functioning systems lead to dry tap stands, resulting in about 45,000 Bundibugyo residents who are reported to be covered but in reality have to walk long distances to the nearest alternative, often an unprotected water source. Bundibugyo has registered an outbreak of either cholera or typhoid fever or both every year for the past 3 years. 
- Only about 7% of 377 surveyed households reported that their village hand pumps had never failed, while the rest reported that their pumps failed nearly every month (14.5%), about twice or more in a year (54%) or once a year (15.6%). Some of the non-functional water sources were considered ‘landmarks’ by the village residents. 
- A survey of 151 water schemes showed that 21.2% were not functional on the day of visit (Welle & Williams, 2014).
- DR Congo: Out of 2,051 water points in three provinces – Bas Congo, Equateur and Kinshasa – non-functionality was highest in Bas Congo at 68%, 24% in Kinshasa and 14% in Equateur (see table below). In Bas Congo only 39% of functional water points provided safe drinking water while in Kinshasa it was just 32% (Hambadiahana & Tolsma, 2012. Water Point Mapping in DR Congo) (SNV, 2013)
- Ethiopia: A survey was carried out with 160 household in 16 water supply systems constructed by different organizations. In Mecha Woreda, 20 of the 21 systems (95%) installed without community support were not functioning while only 12 of the 142 systems (8%) installed with community failed 
- Ghana: In three districts (East Gonja, Akatsi, Sunyani West), more than 30% of the surveyed infrastructure was not functional, and as little as 2% was providing the basic level of service for which it was intended.
- Haiti: A survey of 1096 water kiosks and 2,266 water fountains showed that more than half of existing water kiosks are out of service in four geographical departments: Nord (63%), Sud (60%), Grand’Anse (59%) and Artibonite (53%) and 41.6% of existing water fountains inventoried are not functional.
- Nepal: Of a sample of 192 water points across the country, 26% were found to be non-functional.
- Sierra Leone: A comprehensive water point mapping exercise (more than 28,000 water points) in 2012 showed the rate of damage of public water points is high and rises rapidly with point age. Among points built in 2007, 31% are impaired, and 17% are broken down. Furthermore, up to 40% of protected in-use points providing insufficient water during the dry season (Sierra Leone Ministry of Water Resources, 2012).
- South Sudan: 400 of 578 boreholes built between 2006 and 2012 under the Basic Services Fund were surveyed. 23.2% of surveyed boreholes were not fully functional. The main reasons for reduced functionality were difficulties with pumping and an objectionable taste or color. The 31% of the boreholes for which no information was received were mainly the inaccessible boreholes, or the boreholes constructed by NGOs that had withdrawn from the area. These may also have been the boreholes with a higher occurrence of breakdowns or reduced functionality. 
- Sub-Saharan Africa: In a survey of 23 European Community-funded projects in six sub-Saharan countries:
- Overall, equipment was installed as planned and was in working order. However, fewer than half of the projects examined delivered results meeting the beneficiaries’ needs.
- While the projects examined were sustainable in technical terms, for a majority of projects, results and benefits will not continue to flow in the medium and long term unless non-tariff revenue is ensured; or because of institutional weaknesses (weak capacity by operators to run the equipment installed).
- Swaziland: A pilot water point mapping effort in 8 Tinkhundlas (sub-districts) beginning Nov 2010 showed that out of 2,689 water points, 58.6% are functional, 11.5% are partially functional, and 29.9% are non-functional (Government of the Kingdom of Swaziland Ministry of Natural Resources & Energy, Department of Water Affairs, Water & Sanitation Point Mapping Pilot Project Report 2012).
- Tanzania: One in four public kiosks were not functional at the time of an interview of 324 residents of Dar es Salaam.
- 19% of 79,413 water points are not working. Shallow wells have the highest non-functionality rates (approximately 30%), while protected springs have the lowest non-functionality rate (approximately 88%). As many as 2,303 point water sources (2.9%) are considered abandoned, having been non-functional for five or more years.
- On average, close to 70% of all households surveyed in all the eight districts access low or substandard water services.
- Belarus: 14.5% of rural water supply systems do not meet microbial quality standards and 30.1% do not meet chemical standards.
- Central African Republic: only 10% of the wells and boreholes provide safe water despite these being the main source of water for urban dwellers.
- Dominican Republic: A sustainability assessment of 61 rural water systems found that 18% are unlikely to be sustainable (it is unlikely the community will be able to overcome significant challenges).
- Ethiopia: 25.5% of more than 93,000 water schemes across the country were non-functional according to the National Water Inventory.
- Of 91 water schemes in Farta and West Estie surveyed, 17.5% were not functioning and 10% were functioning with difficulties.
- Kenya: Of 100 water systems assessed (built between 2006-2010), 75% are still in use. 45% are affected by minor technical issues, or even serious damages, although they have the potential to be remediated. 14% of the systems are non-functional.
- Liberia: 40% of over 10,000 improved water points mapped nationally were failed or needed repair.
- The first systematic sampling of water points and study of water quality in Monrovia found that 57% of the water points were contaminated by E. coli, which is an indicator of widespread fecal contamination. The health standard for E. coli is none present/detected. (How a City Gets its Drinking Water: A Case Study – Capital City of Monrovia, Liberia, Vincent W. Uhl, Ashish Daw and Jaclyn A. Baron, 2012)
- 100% of the unprotected hand-dug wells sampled showed the presence of E. coli.
- 75% of the kiosks sampled showed the presence of E. coli.
- 67% of the LWSC city water taps sampled showed the presence of E. coli.
- 52% of the protected hand-dug open wells fitted with hand pumps showed the presence of E. coli.
- 44% of the drilled wells fitted with hand pumps showed the presence of E. coli.
- Malawi: A survey of the water schemes in the early 1980s showed over 90% of taps were functioning, but now only 42.4% are functioning: in the Northern Region, 74% of 2305 taps from gravity-fed piped water schemes are non-functional; in the Central (1,465 taps) and Southern Regions (10,215 taps), 55% of the taps from piped water systems are non-functional (Ministry of Agriculture, Irrigation, Water and Development, 2011).
- Mali: in four municipalities, non-functionality of “modern” water points ranged from 14 to 41% (Jones, 2013).
- Rwanda: In a baseline survey of 126 water points in the District of Kicukiro, 50% of the water points had been down for more than 1 day in the last month, and 55% of the communities reported that they had no spare parts on hand for the water system (Water for People 2011).
- Tanzania: see figure below
Failures of sanitation systems
- Madagascar: 43% of villages that had been declared open defecation free (ODF) now are considered by the community as ODF, while only 25% of all villages were ODF at the time of the survey (75% failure).
- Ethiopia, Kenya, Sierra Leone, Uganda: In a study commissioned by Plan, nearly 5000 households in 116 villages were re-assessed according to the original open defecation free (ODF) verification criteria. If all five criteria listed below are applied, the overall slippage rate across the study was 92%. In all countries each household was expected to have:
- A functioning latrine with a superstructure
- A means of keeping flies from the pit
- Absence of excreta in the vicinity of the house
- Hand washing facilities with water and soap or soap-substitute such as ash
- Evidence that the latrine and hand washing facilities were being used
- India: In Bihar, a common practice once the pit was full was to revert to the practice of open defecation. The percentage of the population going back to open defecation was close to 90% (an educated guess as there is no monitoring of latrine usage).
- South Africa: an informal survey of toilets at schools that fall within four of the National Health Insurance pilot districts found that at all 17 schools the toilets were in a shocking condition.
- Afghanistan: Nationally, 45% of toilets in public schools need extensive repair or replacement.
- Cambodia: In areas where community-led total sanitation (CLTS) methods were used to promote latrine use, only about 15% of households with a latrine use the toilet regularly, while the rest continue to defecate in the open.
- China: There was a "dry ecosan" pilot project (i.e. with using dry toilets) using urine-diverting dry toilets (UDDTs) in multi-story buildings together with other technologies to allow resource recovery from excreta. This project was called the Erdos Eco-Town Project in a town called Erdos in the Inner Mongolia Autonomous Region of China. It was a collaboration between the Dongsheng District government in Erdos and the Stockholm Environment Institute and aimed to save water and provide sanitation services in this drought-stricken and rapidly urbanizing area of northern China. For a variety of technical, social and institutional reasons, the UDDTs were removed after only a few years and the project failed to deliver in the area of nutrient recovery.
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