Water, Sanitation And Hygiene Sector Research Articles

Sector Perspectives on the Attributes of System Approaches to Water, Sanitation, and Hygiene Service Delivery

This study sought to coalesce sector knowledge on the use of systems approaches for sustainable water, sanitation, and hygiene (WASH) service delivery in low-income countries. To accomplish this objective, we remotely convened a panel of WASH sector experts within a multiround survey to identify, characterize, and prioritize the necessary attributes of WASH systems approaches. The first survey round asked experts to comment on the conceptual differences between traditional approaches and systems approaches to WASH. Emerging within responses from the first survey round were attributes of WASH systems (i.e., factors, actors) and attributes of WASH systems approaches (i.e., flexible, scalable). A three-round Delphi survey was then administered to reach consensus on these emerging attributes. By the final round of the Delphi, consensus was reached on every attribute of WASH systems, indicating alignment between the experts on the fundamental characteristics and implications of WASH systems. Consensus was also reached on the majority of attributes of WASH systems approaches, including the inherent interconnected and complex nature of WASH systems. However, consensus was not achieved on attributes related to mapping WASH system interconnections, convening stakeholders in collective action, and the appropriateness and feasibility of applying systems approaches at scale. This indicates a need for future research that explores practical and scalable tools and techniques to map and evaluate WASH system interactions, and ways to engage relevant actors in these approaches to collectively apply systems knowledge.

Strengthening water, sanitation and hygiene governance: a critical review of Zimbabwe's WASH sector institutional arrangements

Abstract This paper sought to review the structural and operational modalities for Zimbabwe's water, sanitation and hygiene (WASH) sector coordination architecture with an objective to identify gaps and recommend areas for further strengthening. Data were collected using a mixed-method approach involving a questionnaire survey, focus group discussions, key-informant interviews and literature review. The study established that the institution of the National Action Committee (NAC) remains incapacitated to effectively deliver on its mandate. Its various committees are failing to convene meetings on regular basis, hence issues take longer to resolve. Decision-making and role clarity among members still remain indistinct, triggering undesirable conflicts. The legitimacy of the institution of the NAC also remains highly questionable, lacking legal bases to back its operations. In terms of information management, structures and systems are in place, only requiring support to make sure they thrive. Finally, financing including intersectoral coordination remains very weak and would need to be built-on, considering the potential of the coordination mechanism to enhance service delivery. A key recommendation emerging from this study is the urgent need for government to commission a review of the current multi-stakeholder platform in the best interest of aligning the coordination structure to the 2013 national constitution and national water policy.

Mobile Health Technologies Are Essential for Reimagining the Future of Water, Sanitation, and Hygiene.

The new Lancet Commission on water, sanitation, and hygiene (WASH) hopes to reimagine and guide global WASH efforts. This comes at a time when unequal living conditions and global disparities in response and recovery have been highlighted by the COVID-19 pandemic and recent large impact trials have delivered mostly disappointing results suggesting the need for radically more effective interventions to improve global public health. We find ourselves at an inflection point in global WASH with an opportunity to build new approaches with potentially more equitable, cost-effective, and scalable solutions. Mobile health (mHealth) technology is an important and innovative tool for WASH advances. Yet, the use of mHealth has not been equally distributed in terms of its benefits nor is its impact guaranteed. In resource-constrained settings, where technology can increase inequalities, special attention should be paid to structural and systemic hierarchies during the development of mHealth programs along with the acknowledgment and understanding how these systems can reinforce the systematic exclusion of those most vulnerable. The WASH sector needs to adapt to a future that is innovative and inclusive with a commitment to rethinking the resources needed to enhance scope and impact. We highlight urban sanitation in Brazil as a case study to demonstrate that mHealth can support and enhance publicly funded infrastructure and to help reimagine WASH for postpandemic and beyond.

Applying a WASH Risk Assessment Tool in a Rural South African Setting to Identify Risks and Opportunities for Climate Resilient Communities.

Climate change threatens the health and well-being of populations. We conducted a risk assessment of two climate-related variables (i.e., temperature and rainfall) and associated water, sanitation and hygiene (WASH)-related exposures and vulnerabilities for people living in Mopani District, Limpopo province, South Africa. Primary and secondary data were applied in a qualitative and quantitative assessment to generate classifications of risk (i.e., low, medium, or high) for components of hazard/threat, human exposure, and human vulnerability. Climate-related threats were likely to impact human health due to the relatively high risk of waterborne diseases and WASH-associated pathogens. Vulnerabilities that increased the susceptibility of the population to these adverse outcomes included environmental, human, physical infrastructure, and political and institutional elements. People of low socio-economic status were found to be least likely to cope with changes in these hazards. By identifying and assessing the risk to sanitation services and water supply, evidence exists to inform actions of government and WASH sector partners. This evidence should also be used to guide disaster risk reduction, and climate change and human health adaptation planning.

Protocol for development and validation of instruments to measure women’s empowerment in urban sanitation across countries in South Asia and Sub-Saharan Africa: the Agency, Resources and Institutional Structures for Sanitation-related Empowerment (ARISE) scales

IntroductionDespite an increasing emphasis on gender and empowerment in water, sanitation and hygiene (WaSH) programmes, no rigorously validated survey instruments exist for measuring empowerment within the WaSH sector. Our objective...

WASH for all: A systematic review of Physiological and Sociological Characterization Framework segmentation in WASH policies, programmes, and projects

SummaryMotivationInitially, governments started with the overarching objective of providing universal access to WASH (water, sanitation, and hygiene) services. During the Millennium Development Goals (MDGs) period 2000–2015, there was increased motivation to understand requirements of different sectors of the population in order to ensure universal, equitable access.PurposeThis article reports findings of a systematic review looking at three questions: what segments of the population have been addressed in WASH policies, and programme and projects? How do the population segments vary between sectors and regions? What barriers, strategies, and benefits for providing WASH services have been identified for different population segments?Methods and approachPopulations can be segmented using two broad paradigms: Physiological Characterization Framework (PCF), which classifies the population on the basis of the life cycle; and Sociological Characterization Framework (SCF), classifying the population on the basis of caste, ethnicity, income, location, and occupation. Policy documents and programme and project (P&P) documents pertaining to the WASH sector were synthesized.FindingsAt a policy level, SCF is used more widely than PCF. In the context of PCF, women were the focus of a relatively large number of policies. Adequacy, environmental, and attitudinal barriers were those most commonly identified across both PCF and SCF segments in WASH policies and P&Ps. In PCF, beneficiary participation and information, education, and communication (IEC) strategies were the more commonly adopted strategies, whereas project management, financing, and provision of services were more frequently adopted for SCF. Availability was the most common benefit identified across PCF and SCF in terms of policy and also P&P.Policy implicationsWASH policies can create an enabling framework by specifically mentioning the different PCF segments in order to facilitate adoption and percolation of the life‐course approach in P&Ps. Incorporating this approach within the current SCF paradigm can help achieve inclusiveness. Greater effort is required to understand barriers faced by PCF segments and to devise strategies to overcome them. Policy‐makers should expand the spectrum of benefits to all categories within PCF in WASH policies.

Placing sustainability at the centre of water, sanitation and hygiene: Knowledge co-production for sectoral transformation

Efforts to expand the delivery of water, sanitation and hygiene (WASH) services are occurring in the context of increasing pressures on the environmental and resource systems on which WASH services depend. As such, it is imperative to explore how sustainability considerations can be made central to WASH initiatives in ways that strengthen both service delivery and environmental systems. This article contributes insights from a transdisciplinary knowledge co-production process designed to bridge conceptual and practical priorities in a sectoral context – the WASH sector – with the intent to inform transformations at multiple levels from local practice through to global discourse. The co-production process was held online with a select group of WASH professionals from 10 countries. The design involved three components: engaging with worldviews and sustainability concepts; discussing the practical relevance of featured research studies in participant's professional roles; and co-creating ideas about desirable futures and transformation pathways. Findings from the process relate to its method, outcomes and implications for future knowledge co-production across four themes: (i) fostering self-reflection and engaging with purpose; (ii) considering sustainability across scales and contexts; (iii) generating ideas for individual and sectoral action; and (iv) reflecting on researcher power and considerations for future co-production processes. The case demonstrates the potential for co-production in a sectoral context to foster generative self-reflection, shared understandings and practical ideas for action towards sustainability transformations. Methodological insights suggest that future knowledge co-production proponents could beneficially emphasize purpose, work across scales and contexts, and take a reflexive approach to power.

Schistosomiasis and Soil-transmitted Helminthiasis Morbidity Control in Selected Communities in Eastern Visayas, Philippines: Post Haiyan

Objective. As part of the evaluation of control programs recommended by WHO, this study describes the local implementation of schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) morbidity control as well as water, sanitation, and hygiene (WASH) interventions post calamity. It likewise determines the challenges, areas for improvement, and good practices in SCH and STH morbidity control strategies in Haiyan-stricken areas in Eastern and Western Samar, the Philippines. Methods. Twenty key informant interviews and eight focus group discussions documented the implementation of SCH and STH control strategies in Eastern Visayas. Data analysis was done manually by a multi-disciplinary team. Results. Mass drug administration (MDA) in schools and communities was conducted for morbidity control. MDA for STH for pre-school-age children was integrated into the Garantisadong Pambata program, while a school-based teacher-assisted approach was used for school-age children. WASH facilities, such as sanitary toilets, were constructed through the initiatives of the local government units (LGUs) and other private sectors. Partnerships with Plan International Philippines helped in the implementation of WASH through the conduct of Community-led Total Sanitation. Health advocacies helped instill behavioral change in the community. SCH surveillance was conducted annually while STH surveillance was irregularly implemented. Data on MDA coverage were validated through Rapid Coverage Assessment before final reporting. Discrepancies were observed due to typographical errors and the inclusion of teachers and transient migrants in the reports submitted. Challenges in the implementation of MDA include delays in drug delivery, lack of human resources, non-compliance of participants, and drug unpalatability. Challenges in WASH included the lack of hand washing facilities, inaccessibility to safe water, as well as non-utility of sanitary toilets. Strengthening health advocacy and education may help address these challenges. Conclusion. The involvement and partnership of various stakeholders such as LGUs, WASH, and veterinary sectors, together with the academe are needed to strengthen and enhance the implementation of SCH and STH control activities. An integrated approach may contribute to improvements in SCH and STH prevention and control of the communities in selected Haiyan-stricken areas.

Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies.

Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies.

Acute health risks to community hand-pumped groundwater supplies following Cyclone Idai flooding

This longitudinal flood-relief study assessed the impact of the March 2019 Cyclone Idai flood event on E. coli contamination of hand-pumped boreholes in Mulanje District, Malawi. It established the microbiological water-quality safety of 279 community supplies over three phases, each comprising water-quality survey, rehabilitation and treatment verification monitoring. Phase 1 contamination three months after Idai was moderate, but likely underestimated. Increased contamination in Phase 2 at 9 months and even greater in Phase 3, a year after Idai was surprising and concerning, with 40% of supplies then registering E. coli contamination and 20% of supplies deemed ‘unsafe’. Without donor support for follow-up interventions, this would have been missed by a typical single-phase flood-relief activity. Contamination rebound at boreholes successfully treated months earlier signifies a systemic problem from persistent sources intensified by groundwater levels likely at a decade high. Problem extent in normal, or drier years is unknown due to absence of routine monitoring of water point E. coli in Malawi. Statistical analysis was not conclusive, but was indicative of damaged borehole infrastructure and increased near-borehole pit-latrine numbers being influential. Spatial analysis including groundwater flow-field definition (an overlooked sector opportunity) revealed ‘hit-and-miss’ contamination of safe and unsafe boreholes in proximity. Hydrogeological control was shown by increased contamination near flood-affected area and in more recent recharge groundwater otherwise of good quality. Pit latrines are presented as credible e-coli sources in a conceptual model accounting for heterogeneous borehole contamination, wet season influence and rebound behavior. Critical to establish are groundwater level - flow direction, hand-pump plume draw, multiple footprint latrine sources - ‘skinny’ plumes, borehole short-circuiting and fast natural pathway (e.g. fracture flow) and other source influences. Concerted WASH (Water, Sanitation and Hygiene) sector investment in research and policy driving national water point based E. coli monitoring programs are advocated.

The Lancet Commission on water, sanitation and hygiene, and health

The Lancet Commission on water, sanitation and hygiene, and health

Evaluation of WASH at Sana’a University as per IWRM Perspective

The Integrated Water Resource Management (IWRM) is considered to be a key in achieving a sustainable improved WASH sector. Water supply and sanitation are among the most essential sectors of development Enhancement of community water supplies and sanitation results in improved social, economic conditions and health. Students are likely to be affected in different ways by inadequate Water, Sanitation and Hygiene (WASH) conditions in schools and universities, so this may contribute to reduce in getting the right learning opportunities. Due to the importance of the WASH sector in improving the community’s level and standards, this paper will help to assess the WASH at Sana’a University.A multi-disciplinary approach to reach the objective targeted in this paper has been used; an intensive literature review has been done, a closedended questionnaire was developed with the help of some INGOs standards such as WHO, UNICEF and Sphere to collect the required data from the beneficiaries, a checklist was developed and used to acquire the requireddata and information from the fields and meet face-to-face with the key informants of each faculty, and all the collected data and information are analyzed with the help of Kobo Toolbox. The findings of the research showed that water shortages and inadequate sanitation were due to weak infrastructure although its own a very strong infrastructure; systems were not repaired or maintained and fell into disuse. In addition, the water supply shortages were also due to insufficient water capacity, physical contaminatedexisting water sources, lack of communication between university officials, and the obstacles to (WASH) sector which include lack of human resources, lack of financial resources, and unclear roles and responsibilities. The recommendation was based on the findings and related issues with water institution, water sector and resource, sanitation, and hygiene in addition to NGOs to support the university WASH infrastructure.Keywords: Water, Sanitation and Hygiene (WASH), Sana’a University, KoboToolbox and IWRM.

Evaluation of WASH at Sana’a University as per IWRM Perspective

The Integrated Water Resource Management (IWRM) is considered to be a key in achieving a sustainable improved WASH sector. Water supply and sanitation are among the most essential sectors of development Enhancement of community water supplies and sanitation results in improved social, economic conditions and health. Students are likely to be affected in different ways by inadequate Water, Sanitation and Hygiene (WASH) conditions in schools and universities, so this may contribute to reduce in getting the right learning opportunities. Due to the importance of the WASH sector in improving the community’s level and standards, this paper will help to assess the WASH at Sana’a University.A multi-disciplinary approach to reach the objective targeted in this paper has been used; an intensive literature review has been done, a closedended questionnaire was developed with the help of some INGOs standards such as WHO, UNICEF and Sphere to collect the required data from the beneficiaries, a checklist was developed and used to acquire the requireddata and information from the fields and meet face-to-face with the key informants of each faculty, and all the collected data and information are analyzed with the help of Kobo Toolbox. The findings of the research showed that water shortages and inadequate sanitation were due to weak infrastructure although its own a very strong infrastructure; systems were not repaired or maintained and fell into disuse. In addition, the water supply shortages were also due to insufficient water capacity, physical contaminatedexisting water sources, lack of communication between university officials, and the obstacles to (WASH) sector which include lack of human resources, lack of financial resources, and unclear roles and responsibilities. The recommendation was based on the findings and related issues with water institution, water sector and resource, sanitation, and hygiene in addition to NGOs to support the university WASH infrastructure.Keywords: Water, Sanitation and Hygiene (WASH), Sana’a University, KoboToolbox and IWRM.

Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox\u2019s bazar, Bangladesh

BackgroundThere is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB.MethodsThe qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces).ResultsKey findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement.ConclusionsAlthough the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.

Understanding the political economy dynamics of the water, sanitation and hygiene (WaSH) sector in Rwanda

ABSTRACT Water, sanitation and hygiene (WaSH) services are examined from the Political Economy Analysis (PEA) perspective in Rwanda. Through a participatory qualitative approach, the findings show that water and sanitation services have been relatively low on the political agenda in Rwanda. There is a shortage of qualified employees at both local and national levels who should be responsible for the WaSH sector. Other major PEA issues include limited accurate, reliable and timely WaSH data to inform decision-making, sustainability of WaSH services and ineffective decentralisation. A range of strategic entry points are suggested in this paper to address these PEA issues.

The political economy of coordinating water, sanitation and hygiene management policies and programmes for Nigeria

ABSTRACT Improving access to water, sanitation and hygiene (WaSH) is at the core of the Global 2030 Agenda for Sustainable Development, but achieving this goal depends on the extent to which policy decisions reflect local science and circumstances. We examine the extent to which the WaSH sector is coordinated in Nigeria through interviews, workshops and literature reviews. Findings demonstrate that WaSH related agencies pursue conflicting goals shaped by international agenda, preferences of donors as well as economic and political interests of actors. These and related factors limit the capacity for coordination, innovation and knowledge sharing for evidence-based and home-grown policies.

‘They will listen to women who speak but it ends there’: examining empowerment in the context of water and sanitation interventions in Ghana

Abstract Gender plays a vital role in shaping access to and governance of water, sanitation, and hygiene (WASH) services in many contexts. Notably, women and men have different WASH-associated roles as well as varying access to resources and power. This study explores the meanings of women's empowerment in the WASH sector from the perspective of local stakeholders in the Asutifi North District, Ghana. A qualitative approach was employed, which involved 15 key informant interviews with community leaders, local government professionals, and WASH practitioners. Participants conceptualized empowerment in terms of four major themes: (1) availability of resources, (2) WASH information, (3) social and cultural structures, and (4) agency. Participants defined empowerment as a multifaceted process shaped by their physical, social, cultural, and political environments. The study provides researchers and practitioners with a greater understanding of the dimensions of empowerment that are relevant to strengthening WASH interventions and practices.

Failure of the "Gold Standard": The Role of a Mixed Methods Research Toolkit and Human-Centered Design in Transformative WASH.

From preventing cholera and diarrhea by reducing exposure to human waste, to reducing transmission of COVID-19 through handwashing, water, sanitation and hygiene (WASH) can save lives. Numerous global health initiatives have been created to combat the spread of infectious diseases. However, according to the Sanitation and Hygiene Fund, “decades of under investment in sanitation and hygiene have made this sector the weakest link in our efforts to achieve the [Sustainable Development Goals (SDGs)].” There appear to be various reasons for the lag in global attention to, funding toward, and innovation around WASH-related diseases. Firstly, WASH is comprised of three interrelated components, water, sanitation, and hygiene, each of which has its own subset of indicators, priorities, and infrastructure, thus making streamlined communications and impact measurement within the sector incredibly complex. Secondly, WASH is a field that bridges many sectors, and there has historically been a lack of understanding of where responsibility lies to consistently fund and execute WASH interventions, programming, and policymaking. Additionally, public health research and funding tend to favor evaluations using randomized controlled trials (RCTs), which are often referred to as the “gold standard.” RCTs, like all single evaluative methods, have limitations which may not effectively capture the complexity of WASH interventions and their subsequent multi-sectoral outcomes. In some cases “it may be infeasible (or unethical) to randomize communities to a [WASH] intervention” which would prohibit the research from reaching the current “gold standard” threshold for academic rigor and subsequent funding. A new concept called “Transformative WASH” has recently emerged in the WASH sector as a result of three RCTs and calls for a “comprehensive package of WASH interventions” to effectively improve health and social outcomes. We believe that the current definition of the “gold standard” in academic research is failing the WASH sector and does not align with “Transformative WASH.” Rather, the “gold standard” should instead be a mixed methods research toolkit that utilizes Human-Centered Design (HCD) practices, and proxy methods such as “participatory design” or “Behavior Centered Design theory” to better design and evaluate WASH interventions.

The Role of Water, Sanitation, Hygiene, and Gender Norms on Women's Health: A Conceptual Framework

While the health impact of poor water, sanitation, and hygiene (WASH) conditions on children have been well documented, there has been less focus paid to its adverse impact on women's well-being and health. In this article, I highlight the health burden of water and sanitation insecurities for women by proposing a conceptual framework for understanding WASH-related diseases from a gender perspective, focused primarily on resource poor countries. The framework draws on feminist perspectives to examine how WASH insecure communities constrain women's functionings and capabilities. I identify eight different social–cultural pathways that fall into two synthetic constructs—gendered relations in the household and gendered presentation of the body—because they illustrate how social and cultural norms may burden women and put them at risk of exposure to a variety of WASH-related diseases. I use the critical interpretive synthesis methodology and draw on research from the fields of epidemiology, medicine, and social sciences to develop this conceptual framework that connects WASH-related diseases to gender norms that oppress women. The gender perspective proposed here has important implications for women living under poor water and sanitation conditions and for the WASH sector more broadly. It suggests providing women with direct financial assistance to purchase sanitary material, collecting sex-disaggregated data on sanitation access and on the health impact of gendered WASH-related tasks to improve women's health and quality of life.

The H in WASH: a reflection on the contribution, style and legacy of Professor Val Curtis

Abstract In this paper we reflect on the contribution, style and legacy of Professor Val Curtis, an important, and sometimes controversial, figure in the water, sanitation and hygiene (WASH) sector who sadly passed away on October 19, 2020. Across numerous scientific articles, and several books, and operational programmes, she established herself as a world-renowned scientific expert in the field of hygiene and behaviour change, as well as a major thought-leader in the WASH sector. We identify four major scientific contributions which she made over three decades of research that spanned multiple fields, including engineering, epidemiology, and psychology. Beyond her research, she tirelessly championed hygiene as a public health priority, using her talents as a communicator to secure concrete changes in relevant policy and practice. We are confident that her example, as both a public health researcher, and as a hygiene champion, will inspire future generations of WASH researchers and practitioners to be bold and ambitious.