The poor bear the brunt of the burden of inadequate water, sanitation and hygiene (WASH) and the link between WASH and health is undeniable. An estimated 842,000 people die each year due to diarrheal disease that could have been prevented by WASH interventions; 361,000 are children under the age of five years old. Health impacts go beyond diarrheal disease: half of global malnutrition and one quarter of stunting in children are due to waterborne diseases like chronic diarrhea and intestinal worms, and diarrhea is responsible for 17% of global disability (PMNCH, 2014).
The Sustainable Development Goals (SDGs), recently adopted by the United Nations, have sparked a renewed focus on what strategies will be necessary to achieve universal access to safe water and basic sanitation by 2030. This won’t be an easy goal to reach – how we define the challenges will influence our direction and prospects for success.
CAWST sees five main challenges to achieving sustained, universal access to safe water and sanitation:
- The scale of the need for safe water, sanitation and hygiene.
- The variability of water and sanitation problems and consequently the variability of solutions from place to place and from time to time.
- How to best sustain essential WASH services over the long-term.
- How to reach people most in need.
- The integration of water, sanitation and hygiene for health.
The Scale of the Need – Water, Sanitation and Hygiene to Half the World’s Population
The sheer scale of the issue is a challenge in itself. It will be no small feat for half the world’s population to gain sustained access to safe water, basic sanitation and good hygiene practices (and to do so in 15 years).
Even critical institutions like health care facilities and schools lack water and sanitation. A study in 54 low- and middle-income countries found that 38% of health care facilities lack access to an improved water source, 19% lack sanitation and 35% do not have water and soap for handwashing (World Health Organization & United Nations’ Children’s Fund, 2015).
The scale of the need will increase, particularly as populations grow, available freshwater is used and contaminated at increasing rates, and the climate changes.
To date, solutions have tended toward infrastructure, implemented by a few organizations. This approach alone has not been successful in reaching everyone, and there aren’t enough local people with the required knowledge and skills to deliver universal, safely-managed WASH by 2030. The current formal systems for training, such as university and vocational programs, are important but will not produce enough WASH practitioners to meet the demand by 2030.
No single solution will result in universal access by 2030. A range of adaptable and scalable solutions are needed to overcome geography, gender and socioeconomic barriers.
Solutions will require many organizations working cohesively to provide smaller-scale, decentralized WASH services, especially at the household level. Those many organizations need support and increased capacity in order to reach unserved populations with sustained WASH services.
The Variability of the Problem and Therefore the Solutions
Water and sanitation issues are highly variable from location to location, from season to season and community to community; and people who lack WASH are often living in the most challenging geography and climate.
One-size-fits-all solutions have not worked and cannot be the strategy to scale-up reach. For example, water quality, rainfall and hydrology are site-specific and have important implications on technology selection and siting. Incorrect choices can exacerbate an already poor condition (e.g. digging a simple pit latrine that further contaminates groundwater).
Customized water and sanitation services are needed that capitalize on existing local knowledge of conditions; and local people need to have the capability to make informed choices and be able to respond effectively to changing conditions.
Sustaining Water, Sanitation and Hygiene Services for the Long-Term
Focus over the past decades has been on water and sanitation infrastructure. This approach is costly in up-front capital, operations and ongoing maintenance. It requires a highly educated, skilled workforce and often doesn’t reach the most marginalized communities, nor address specific contextual challenges.
Sustained operation and maintenance of this infrastructure has been challenging. For example, 30% of water hand-pumps in Africa are not working (RWSN, 2009). The failure of community water and sanitation systems is often a failure of operation and maintenance, rather than a failure of the basic technology.
Addressing this failure requires learning from the successes of those infrastructure that have been used and maintained for many years. At its core, we need to (i) increase skills and knowledge of people to use and maintain the technology and/or service and (ii) select water and sanitation products and services – including household-level solutions – which are affordable to implement, operate and maintain and appropriate to the context.
Reaching People Most in Need
Overwhelmingly, it is the poorest who lack better water and sanitation. Virtually the entire poorest 25% of the world’s population does not have piped water and the inequality in coverage between rich and poor is even greater for sanitation than for water (JMP, 2014).
Addressing this challenge requires both supporting those who serve the people most in need and providing water and sanitation solutions that marginalized households can afford over the long-term.
Integrating Water, Sanitation and Hygiene (WASH) for Health
Many of the water and sanitation approaches employed to date in international development focus on providing either improved water or improved sanitation or improved hygiene. Global monitoring programs, such as the Joint Monitoring Program of UNICEF and the WHO count access to each of the three separately. Alternatively, organizations have the vision to implement all three and struggle to do so when faced with the realities on the ground.
All three – water, sanitation and hygiene – are intertwined and all three are needed for sustained impact. Water, sanitation and hygiene are fundamental for healthy homes and broader systemic change.
The question is then how to implement so people have water and sanitation and hygiene for generations? Start with interventions that will be (i) the easiest for households to adopt immediately and for the long-term, and (ii) provide an entry-point for motivating action on other WASH components. Furthermore, longer term commitments are needed that work towards households having all three components: water, sanitation and hygiene.
Overcoming Challenges to Reach Everyone by 2030
Addressing these five challenges will go a long way towards achieving universal access to safe water and sanitation by 2030. We will reach that goal through many organizations implementing many projects of varying scale, technology and approach.
There are thousands of existing local organizations and government agencies that are best-suited to reach their own populations with safe water and basic sanitation. In the weeks, months and years ahead, alongside these organizations, we need to build capacity, create and sustain demand, provide products and services, monitor for improvement and provide appropriate financing.
In this way, we can collectively achieve sustained services for generations to come.
JMP [Joint Monitoring Programme] (2014). Progress on Drinking Water and Sanitation 2014 Update. WHO Press. Geneva.
PMNCH [The Partnership for Maternal, Newborn, & Child Health] (2014). PMNCH Knowledge Summary #30 Water, sanitation and hygiene – the impact on RMNCH. Available at:www.who.int/pmnch/knowledge/publications/summaries/ks30/en/
Prüss-Ustün, A., Bartram, J., Clasen, T., Colford, J. M., Cumming, O., Curtis, V., et al. (2014). Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries. Tropical Medicine & International Health, 19(8), 894–905. Available at: http://doi.org/10.1111/tmi.12329
RWSN [Rural Water Supply Network] (2009) Handpump Data 2009. Selected Countries in Sub-Saharan Africa, RWSN, St Gallen, Switzerland
WHO [World Health Organization] and UNICEF [United Nations Children’s Fund] (2015) Water, sanitation and hygiene in health care facilities: Status in low- and middle-income countries and way forward. WHO Press. Geneva.