Water, Sanitation And Hygiene Sector Research Articles

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.

Preprocessing alternatives for compositional data related to water, sanitation and hygiene

The Sustainable Development Goals (SDGs) 6.1 and 6.2 measure the progress of urban and rural populations in their access to different levels of water, sanitation and hygiene (WASH) services, based on multiple sources of information. Service levels add up to 100%; therefore, they are compositional data (CoDa). Despite evidence of zero value, missing data and outliers in the sources of information, the treatment of these irregularities with different statistical techniques has not yet been analyzed for CoDa in the WASH sector. Thus, the results may present biased estimates, and the decisions based on these results will not necessarily be appropriate. In this article, we therefore: i) evaluate methodological imputation alternatives that address the problem of having either zero values or missing values, or both simultaneously; and ii) propose the need to complement the point-to-point identification of the WHO/UNICEF Joint Monitoring Program (JMP) with other robust alternatives, to deal with outliers depending on the number of data points. These suggestions have been considered here using statistics for CoDa with isometric log-ratio (ilr) transformation. A selection of illustrative cases is presented to compare performance of different alternatives.

Intersectoral (in)activity: towards an understanding of public sector department links between water, sanitation and hygiene (WASH) and childhood undernutrition in South Africa.

Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), contribute to poor child health, nutritional status and physical growth. The primary responsibility for the provision of water and sanitation, as a basic service and human right, lies with the State, as such, a number of stakeholders are involved. Despite relatively high levels of WASH infrastructure coverage in South Africa, enteric infections and stunting remain high for a middle-income country. The aim of this study is to elucidate the landscape of WASH in South Africa in relation to nutritional status of children under the age of 5 years in the South African, Gauteng and City of Johannesburg contexts. The authors detailed the national and provincial public sector departments and through purposive sampling proceeded to map the various departments and associated policies that are responsible for the provision of WASH facilities, as well the nutritional status of children. Of the six policies identified for review, three mentioned WASH, nutrition and children; however, none explicitly linked WASH to nutritional status in children. An in-depth review and analysis of these three crucial policy documents was conducted. Finally, a set of expert interviews were conducted and a consensus development conference convened, with experts at the intersection between WASH and nutritional status. The authors found that the public sector would benefit from better integration of the concept of WASH into their policy, planning and implementation frameworks. The WASH sector should emphasize the role in which WASH plans consider the impact of WASH on the nutritional status of children. The various public sector departments involved in WASH service provision, and other WASH stakeholders, including community-based organizations, non-governmental organizations and intergovernmental organizations, should be involved in the decision-making of the nutrition sector.

Social Network Analysis for Water, Sanitation, and Hygiene (WASH): Application in Governance of Decentralized Wastewater Treatment in India Using a Novel Validation Methodology

Social network analysis (SNA) is a versatile and increasingly popular methodological tool to understand structures of relationships between actors involved in governance situations. Given the complexity of the set of stakeholders involved in the governance of Water, Sanitation and Hygiene (WASH) and the diversity of their interests, this article introduces SNA to the WASH sector. The use of SNA as an appropriate diagnostic tool for Citywide Inclusive Sanitation is explored. Missing data is a major problem for SNA in the studies of governance situations, especially in low- and middle-income countries. Therefore, a novel validation methodology for incomplete SNA data, relying on information from internal and external experts is proposed. SNA and the validation method is then applied to study the governance of decentralized wastewater treatment in four cities of India. The results corroborate key differences between mega and secondary cities in terms of institutions, community engagement and overall sanitation situation including aspects of decentralised wastewater treatment plants, based on the city types.

The impact of the private provision of WASH services on sustainable economic growth in sub-Saharan Africa

This paper analyzes the expanded role of the private sector in the provision of water, sanitation, and hygiene (WASH) services in Africa. Since 2010, private capital has entered the WASH sector throughout the continent via innovative mechanisms such as municipal bonds and equity funds. The surge of capital has attempted to fill the $2.5 trillion annual investment gap that the United Nations (2014) estimates for key development sectors. A tension exists, however, between the private-sector-enabled provision of WASH services and key Sustainable Development Goals, particularly offering affordable water and ending chronic poverty. For example, the World Bank (2016) recently found that in countries that declare the right to “free” water, an underserved impoverished class often must pay a much higher price for water than the rich. The current analysis provides an empirical inquiry into the conditions under which the private sector is attracted to the provision of WASH services and estimates its subsequent impact on both economic growth and inclusive development.

Review of Public Financing for Water, Sanitation, and Hygiene Sectors in Vietnam.

Background:Vietnam declared its national roadmap towards Sustainable Development Goals number 6 by 2030. However, specific supporting programmes and financial means to proceed with the roadmap have not been passed on. Evidence on the financing for water, sanitation, and hygiene (WASH) being allocated or spent has not been well documented in Vietnam. This study aimed to obtain an overview and assessed the public funding across the WASH sector of Vietnam in 3 fiscal years 2016, 2017, and 2018.Methods:A cross-sectional study was conducted for information about the public financing for WASH at both national and sub-national levels. An activity-based costing approach was applied to determine WASH-related public expenditure. Fourteen focus group discussions with key stakeholders were used to identify the WASH activities and to access financial reports of these relevant institutions. TrackFin methodology was used to assemble the public financing for WASH in Vietnam.Results:The public expenditure of WASH declined by about 30.7% over the 3 fiscal years, from US $2016 million in 2016 to US $1397 million in 2018. Meanwhile, this expenditure allocated to the poor or mountainous areas increased by 3 folds. The highest proportion of WASH public funding was invested in sanitation through large network systems (59.07% of the total public expenditure), whereas the lowest was in hygiene promotion and handwashing facilities. The domestic budget was still the main source of public financing for WASH services, with 2 largest shares coming from government revenues (47.24%) and repayable loans (20.49%).Conclusion:The main source of financing for WASH was from the government, yet its public expenditure has been decreased. A refined roadmap with specific steps for a sustainable WASH financing system in Vietnam, particularly to leverage government and private sector resources, is required to ensure no one is left behind.

Understanding empowerment in water, sanitation, and hygiene (WASH): a scoping review

AbstractIn low- and middle-income countries, a common component of water, sanitation, and hygiene (WASH) interventions is the goal of empowerment of beneficiaries, particularly poor households. Empowerment is viewed as an important development goal in itself, as well as a way to obtain improved WASH outcomes. However, empowerment is a complex and multi-dimensional concept, and it is often not clear how it is defined in WASH sector programming. This scoping review explores how concepts of empowerment have been used in the WASH sector and delineates relevant empowerment dimensions. Medline, Embase, and Global Health databases were searched for in the peer-reviewed literature published in English. A total of 13 studies were identified. Five major interrelated empowerment dimensions were identified: access to information, participation, capacity building, leadership and accountability, and decision-making. This review provides researchers and practitioners with a greater understanding of dimensions of empowerment that are relevant for strengthening WASH interventions, as well as tracking progress toward gender and social equality outcomes over time. This understanding can help ensure inclusive WASH service delivery to achieve gender-sensitive Sustainable Development Goal (SDG) targets for universal water and sanitation access.This article has been made Open Access thanks to the generous support of a global network of libraries as part of the Knowledge Unlatched Select initiative.

Concept mapping: Engaging stakeholders to identify factors that contribute to empowerment in the water and sanitation sector in West Africa.

Research has shown that inadequate access to water, sanitation, and hygiene (WASH) affects women and girls in several ways, including lowering their participation in the labour market and community activities and contributing to psychosocial stress and poor educational outcomes. There is growing awareness that addressing the gender inequalities related to WASH that many women and girls face on a daily basis must go beyond focusing on delivery of infrastructure and facilities alone and include attention to issues of empowerment. Yet there is limited exploration of how the concept of empowerment is defined and applied in the WASH sector and thus limited information on how it could be measured. This study used concept mapping to uncover the meaning and key dimensions of empowerment in WASH among 34 and 24 stakeholders in Asutifi North District, Ghana, and Banfora Commune, Burkina Faso, respectively. The study was part of initial steps toward choosing indicators for developing an Empowerment in WASH Index. In Ghana and Burkina Faso, 42 and 29 items were generated, respectively. These items were thought to empower men and women in WASH at the household and community levels. In both case studies, 7 clusters were generated and named by participants, and themes related to sharing of information, sociocultural norms, participation, and accessibility of WASH services were associated with empowerment. Some themes were unique to each case study site. Participants also showed a multidimensional and multilevel understanding of empowerment. Concept mapping created an effective balance between individual and group contributions and facilitated accessible, rapid, and contextually relevant data collection. The findings can be used to generate domains of empowerment in future quantitative research as well as inform the design of the Empowerment in WASH Index.

Translating pathogen knowledge to practice for sanitation decision-making.

Sanitation planners make complex decisions in the delivery of sanitation services to achieve health outcomes. We present findings from a stakeholder engagement workshop held in Kampala, Uganda, to educate, interact with, and solicit feedback from participants on how the relevant scientific literature on pathogens can be made more accessible to practitioners to support decision-making. We targeted Water, Sanitation and Hygiene (WASH) practitioners involved in different levels of service delivery. Practitioners revealed that different sanitation planning tools are used to inform decision-making; however, most of these tools are not user-friendly or adapted to meet their needs. Most stakeholders (68%) expressed familiarity with pathogens, yet less than half (46%) understood that fecal coliforms were bacteria and used as indicators for fecal pollution. A number of stakeholders were unaware that fecal indicator bacteria do not behave and persist the same as helminths, protozoa, or viruses, making fecal indicator bacteria inadequate for assessing pathogen reductions for all pathogen groups. This suggests a need for awareness and capacity development around pathogens found in excreta. The findings underscore the importance to engage stakeholders in the development of support tools for sanitation planning and highlighted broader opportunities to bridge science with practice in the WASH sector.

Estimating access to drinking water and sanitation: The need to account for uncertainty in trend analysis

Nationally representative household surveys are the main source of data for tracking drinking water, sanitation and hygiene (WASH) coverage. However, all survey point estimates have a certain degree of error that must be considered when interpreting survey results for policy and decision making. In this article, we develop an approach to characterize and quantify uncertainty around WASH estimates. We apply it to four countries – Bolivia, Gambia, Morocco and India – representing different regions, number of data points available and types of trajectories, in order to illustrate the importance of communicating uncertainty for temporal estimates, as well as taking into account both the compositional nature and non-linearity of JMP data. The approach is found to be versatile and particularly useful in the WASH sector, where the dissemination and analysis of standard errors lag behind. While it only considers the uncertainty arising from sampling, the proposed approach can help improve the interpretation of WASH data when evaluating trends in coverage and informing decision making.

Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene

Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene

Social and feminist design in emergency contexts: the Women’s Social Architecture Project, Cox's Bazar, Bangladesh

ABSTRACTThe rapid influx of Rohingya refugees into Cox's Bazar, Bangladesh, has led to the formation of huge camps, built on difficult terrain, short of space and with high population density. All these factors present numerous challenges to agencies seeking to provide latrines, water points, and bathing facilities. Feedback gathered from women and girls highlighted significant challenges around access, safety, privacy, and dignity, including management of personal hygiene and menstruation. Within the humanitarian community, site planning and WASH (water, sanitation and hygiene) infrastructure planning/design processes have mainly been dominated by male architects and engineers, often with gendered assumptions about the user. Acknowledging these challenges, Oxfam implemented the Women’s Social Architecture Project to work with women and adolescent girls, and female architects with a background or interest in social or feminist design and architecture, to add a different perspective into the design and siting of WASH facilities. The project has consisted of formative research with Rohingya women and girls, and design workshops with architects in which Rohingya women have co-created designs that tackle the issues they face regarding WASH facilities. This article provides an account of the progress to date, together with feedback from women and girls and the WASH Sector in Cox's Bazar ahead of the final completion of the project in June 2019.

Dimensions of Inequality in Urban and Rural Water, Sanitation and Hygiene Services in Sub-Saharan Africa

The attainment of the Sustainable Development Goals (SDGs) for water, sanitation and hygiene (WASH) requires the elimination of all forms of inequalities in WASH services. Hence, this study was aimed at the assessment of the dimensions of inequality in urban and rural WASH services in sub-Saharan Africa. This study adopted a descriptive design based on secondary data obtained from the 2015, Joint Monitoring Programme (JMP) report that contains global estimates on WASH services. The obtained data were presented in tables and analyzed using percentages. The study revealed that generally there exist inequalities in WASH services at different levels in the region and particularly between urban and rural areas. These disparities are threats toward the attainment of the SDGs for WASH in the region. To avoid these threats, all countries in the region must develop WASH policies that eliminate inequalities to WASH services, promote education and alleviate poverty; reduce corruption in the WASH sector and develop the capacity of institutions charged with WASH services with improved funding and accountability.

Assessment of Water, Sanitation and Hygiene Services in Sub-Saharan Africa

Adequate provision of water, sanitation and hygiene (WASH) facilities are supporting pillars of healthy living. Hence, this review was aimed at the assessment of the status of WASH services in sub-Saharan Africa. The study used secondary data, sourced from the Joint Monitoring Programme (JMP) report by UNICEF and WHO (2015). This data was used to assess the WASH status of sub-Saharan Africa. Other information highlighted in the paper were obtained from existing literature, in peer reviewed journals, conference proceedings, commissioned studies and the internet. Data obtained were presented in tables and further analyzed using percentages. The review revealed thatWASH services are poorly provided in sub-Saharan Africa, with negative consequencies on the health and socio-economic development of people who have poor access to WASH services. Some of the reasons that have led to the poor provision of WASH services in the region are broadly classified into natural and human-related. The natural causes are the region’s extreme climate and rainfall variability, which has been made worst by climate change, resulting in desertification, shrinkage of some water bodies and growing water scarcity; while the human-related causes include, poor governance, weak institutions, poor financing, and corruption in the WASH sector, amongst others. The study recommends the adoption of a comprehensive, inclusive and integrated WASH strategy that fit the peculiarities of each country in the region. This would help in maximizing the benefits of WASH services and the promotion of healthy living in the region.

Water, Sanitation, and Hygiene in Pakistan: An Assessment of the Support of the World Bank and the Asian Development Bank (2000-2016)

An effective Water Sanitation and Hygiene (WASH) is considered as one of the building blocks for the health of a populace. Unfortunately, this sector in Pakistan is quite fragile, and the intensity of fragility varies from one unit of the state to the other. However, for the development of WASH in Pakistan, the Asian Development Bank (ADB) and the World Bank (WB) are providing assistance in project preparation and implementation. This paper outlines the causes of the poor condition of WASH sector in Pakistan. Moreover, it evaluates the interventions of the ADB and the WB in the country from 2000-20016. It is also pondered over whether or not these interventions have brought betterment in WASH sector in different provinces of Pakistan. More importantly, the paper also highlights loopholes in the developmental strategies of ADB and WB and suggests few possible strategies for the development of the WASH sector.

Framework for WASH Sector Data Improvements in Data-Poor Environments, Applied to Accra, Ghana

Improvements in water, sanitation and hygiene (WASH) service provision are hampered by limited open data availability. This paper presents a data integration framework, collects the data and develops a material flow model, which aids data-based policy and infrastructure development for the WASH sector. This model provides a robust quantitative mapping of the complete anthropogenic WASH flow-cycle: from raw water intake to water use, wastewater and excreta generation, discharge and treatment. This approach integrates various available sources using a process-chain bottom-up engineering approach to improve the quality of WASH planning. The data integration framework and the modelling methodology are applied to the Greater Accra Metropolitan Area (GAMA), Ghana. The highest level of understanding of the GAMA WASH sector is achieved, promoting scenario testing for future WASH developments. The results show 96% of the population had access to improved safe water in 2010 if sachet and bottled water was included, but only 67% if excluded. Additionally, 66% of 338,000 m3 per day of generated wastewater is unsafely disposed locally, with 23% entering open drains, and 11% sewage pipes, indicating poor sanitation coverage. Total treated wastewater is <0.5% in 2014, with only 18% of 43,000 m3 per day treatment capacity operational. The combined data sets are made available to support research and sustainable development activities.

Improving environmental conditions for involuntarily displaced populations: water, sanitation, and hygiene in orphanages, prisons, and refugee and IDP settlements

Abstract Access to water, sanitation, and hygiene (WaSH) services for involuntarily displaced populations is an important component of Sustainable Development Goal 6: achieving universal and equitable access to basic WaSH services by 2030. To date, households have been the main priority in the WaSH sector, and other settings have received less attention. Ensuring that involuntarily displaced persons have adequate WaSH and environmental health services is of critical importance for human rights and development outcomes. The Water Institute at the University of North Carolina (UNC) at Chapel Hill and World Vision organized a side event at the 2017 UNC Water and Health conference to discuss obstacles and opportunities related to improving environmental conditions in orphanages, prisons, and refugee and Internally Displaced Persons (IDP) settlements. Participants discussed the characteristics of each setting in breakout discussion groups, and then came together to discuss the similarities and differences between the three settings. Our goal was to allow common themes and lessons to emerge and to develop recommendations and shape future research. This side event provided an opportunity for participants from different professional backgrounds to share their experiences working with involuntarily displaced populations and discuss ways forward.

Optimizing household survey methods to monitor the Sustainable Development Goals targets 6.1 and 6.2 on drinking water, sanitation and hygiene: A mixed-methods field-test in Belize.

BackgroundThe Sustainable Development Goals (SDGs) require household survey programmes such as the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) to enhance data collection to cover new indicators. This study aims to evaluated methods for assessing water quality, water availability, emptying of sanitation facilities, menstrual hygiene management and the acceptability of water quality testing in households which are key to monitoring SDG targets 6.1 and 6.2 on drinking Water, Sanitation and Hygiene (WASH) and emerging issues.MethodsAs part of a MICS field test, we interviewed 429 households and 267 women age 15–49 in Stann Creek, Belize in a split-sample experiment. In a concurrent qualitative component, we conducted focus groups with interviewers and cognitive interviews with respondents during and immediately following questionnaire administration in the field to explore their question comprehension and response processes.FindingsAbout 88% of respondents agreed to water quality testing but also desired test results, given the potential implications for their own health. Escherichia coli was present in 36% of drinking water collected at the source, and in 47% of samples consumed in the household. Both questions on water availability necessitated probing by interviewers. About one quarter of households reported emptying of pit latrines and septic tanks, though one-quarter could not provide an answer to the question. Asking questions on menstrual hygiene was acceptable to respondents, but required some clarification and probing.ConclusionsIn the context of Belize, this study confirmed the feasibility of collecting information on the availability and quality of drinking water, emptying of sanitation facilities and menstrual hygiene in a multi-purpose household survey, indicating specific areas to improve question formulation and field protocols. Improvements have been incorporated into the latest round of MICS surveys which will be a major source of national data for monitoring of SDG targets for drinking water, sanitation and hygiene and emerging issues for WASH sector programming.

Mainstreaming gender in the WASH sector: dilution or distillation?

ABSTRACT The way women’s issues have been conceptualised and acted on in the context of water, sanitation, and hygiene (WASH) has changed over the past four decades. The discourses and trends in development studies – from the Women in Development approach of the 1970s to Gender and Development in the 1980s – were mirrored in the WASH sector. The WASH sector has contributed to, and been shaped by, debates on women’s needs and, latterly, on gender perspectives based on a combined argument for equity and efficiency. In addition, in the last decade, the WASH sector has developed its own distinctive initiatives, such as menstrual hygiene management and, recently, specific WASH considerations relating to gender-based violence. This paper assesses whether the result of this sector-specific response has been a dilution or distillation of gender issues. It concludes that the WASH sector has not disregarded the goals of women’s empowerment and gender equality; rather, it has contributed to understandings of how resources – such as infrastructure and services – underpin that empowerment. This allows an important recognition of the value and impact of WASH-sector priorities and actions for the wider well-being of women.

Climate change vulnerability and resilience of water, sanitation, and hygiene services: a theoretical perspective

In this paper we outline different theoretical approaches, namely outcome vulnerability, contextual vulnerability, and resilience, for addressing climate change effects in the context of water, sanitation, and hygiene (WASH) services. We analysed how these three approaches were employed in the WASH-climate change nexus literature, and discuss the implications for WASH research, policy, and development work. Our analysis of 33 scholarly WASH-climate change nexus papers found that they implicitly drew most frequently on an outcome vulnerability approach that tended to focus on the impact of projected climate change hazards on physical aspects of WASH service delivery. Each individual approach has limitations due to their disciplinary and epistemological foundations and the WASH sector in particular must be mindful of who stands to benefit most and what values will be upheld when these approaches are used. We argue that in most cases it will be beneficial to draw on all approaches and describe challenges and opportunities for integrating different perspectives on preparing for climate change within the WASH sector.