Addressing water, sanitation and hygiene inequalities: A review of evidence, gaps, and recommendations for disability-inclusive WASH by 2030

Abstract

One in six people worldwide experiences significant disability. Many of these people living in low-and middle-income countries (LMICs) are disproportionately affected by inadequate access to water, sanitation and hygiene (WASH) services, a fundamental necessity for health and well-being. This review aimed to examine the existing evidence on disability and WASH in LMICs, identify gaps and make recommendations to strengthen disability-inclusive WASH research, policies and practices to make significant progress by 2030. While evidence of WASH challenges faced by people with disabilities has grown in the last decade, revealing significant inequalities, there is a lack of controlled studies to assess the impact of disability-inclusive WASH interventions. This research gap makes it difficult to prioritise investments for scalable solutions. This review proposes three key recommendations: 1) Further expand research on WASH challenges faced by people with disabilities, prioritising climate risks, health impacts, and educational inequalities. 2) Design and test evidence-based disability-inclusive WASH interventions. 3) Rigorously evaluate these interventions to determine what successfully reduces WASH disparities for people with disabilities and their caregivers cost-effectively. This review is the first to synthesise available evidence across disability and WASH and offer a roadmap for future efforts to drive improvements in disability-inclusive WASH by 2030.