Poor access to water, sanitation, and hygiene—collectively known as WASH—is responsible for more than half of diarrhea cases . Exposure to enteric pathogens in the environment due to poor WASH can lead to long-term gut damage, compromising a child’s physical and cognitive growth. Good health is simply not possible without WASH.
WASH in institutional settings, such as health centers and schools, is critically important and is generally agreed to be one of the key integrated interventions for tackling stunting. However, an expansive study of 54 countries and 66,101 facilities revealed that 38 percent of health care facilities do not have a clean water source, 19 percent do not have improved sanitation, and 35 percent do not have water and soap for handwashing.
– Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization (WHO)
in a WHO statement
– Stephen Luby, lead of the groundbreaking WASH Benefits Study in Bangladesh. The results from the studies in Bangladesh and Kenya, which looked at the impact of WASH and nutrition interventions on child stunting, is prompting important conversations among practitioners about the need for more robust coverage of WASH programs. Read WaterAid’s data analysis.
Water can be contaminated at its source, during transportation, or at the point of consumption. Drinking or using unsafe water for washing, cooking, cleaning, or farming can lead to illnesses. This burden, and the constant search for a water supply, even when unsafe, falls most heavily on girls and women.
This problem is critical in sub-Saharan Africa and Southeast Asia, where rural and poor communities lack infrastructure that ensures safe drinking water. Rapid urbanization is putting new pressures on flawed water systems. People are more likely to be exposed to contaminated water in countries where infrastructure may be lacking or failing. Climate change is also an exacerbating factor. Droughts can dry up water sources, leading people to use any water they can find, even if highly contaminated. Additionally, floods are more likely to lead to contamination as water sources overflow or surge and stress infrastructure.
Solutions that make water safe must be tailored to meet local needs. Education and behavior-change tactics are also important to sustainability. Point-of-use and household water treatment and storage involve disinfecting water before it is used or consumed. There are a range of proven, low-cost methods, including disinfection by sun, UV lamps, boiling, filtration, and absorption, as well as chemical disinfection with chlorine, bleach, and flocculants. Innovation to address unsafe water may be as specific as an adapter ring in a water filter that accommodates several sizes of ceramic pots, or a design upgrade that encourages use. Once water is treated, it must be stored safely to prevent subsequent contamination.
Engagement with the private sector can help, too.
Everything from direct sales of water filters to automated water kiosks and ATMs may change the landscape of water providers. Learn more:
If everyone had access to safe water, almost 90 percent of diarrheal deaths could be prevented.
The Sustainable Development Goals (SDGs), launched in 2015, include a target to ensure everyone has access to safe water by 2030.
Goal 6: Ensure availability and sustainable management of water and sanitation for all.
6.1: Achieve universal and equitable access to safe and affordable drinking water.
6.1.1: Proportion of population using safely managed drinking water services. Learn more.
WHO’s guidelines on drinking water quality provide the basis for national regulations and standards for water safety in support of public health.
The latest guidelines for drinking water quality can be found here.
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Safely collecting, treating, and disposing of human waste reduces exposure to the causes of enteric disease.
Lack of basic sanitation (e.g., open defecation) creates serious health risks, including endemic diarrhea and the spread of diseases like cholera, diarrhea, and dysentery. It is also linked to transmission of hepatitis A, typhoid, and polio.
Evidence shows a total community approach to sanitation coverage is needed in order to have a meaningful impact. Estimations show that 60 to 65 percent coverage in a community is required before any impact can be seen. A study in India showed that 25 percent of the effect of diarrheal disease reduction was due to a child’s access to his/her own sanitation facility; by contrast, 75 percent of the effect came from having a high level of sanitation in the village.
The lack of access to basic sanitation facilities can also have serious safety implications, especially for women at night, and undermine feelings of self-dignity.
The vast majority of people without access to proper sanitation live in sub-Saharan Africa, East Asia, and South Asia. Unless addressed, the problem will only continue, with rapid urbanization and climate change presenting growing threats.
Sanitation can be improved by addressing user-, product-, and market-related challenges that inhibit uptake and use of sanitation technologies. Leading sanitation solutions engage and create incentives for all actors across the sanitation value chain.
Everyone needs a safe place to go. Proper sanitation means that people are separated from and do not come into contact with human waste. Squat pan or seated pour-flush toilets, onsite biodigesters, or public latrine blocks are all appropriate for varying contexts. However, it is important to recognize there is no “one size fits all” solution to sanitation. The right intervention depends on the community’s needs, culture, and environment. And a critical element of an intervention is ensuring that facilities are used and maintained. This can sometimes mean taking on cultural norms.
Durability, privacy, and security
These were among the key user requirements for a joint Population Services International (PSI) and PATH sanitation project in rural India. The collaboration helped build a market for the sale of 150,000 toilets that are designed to be cost-effective and user-friendly. Addressing supply chain challenges, creating user-centered designs, and providing financing options for families to purchase their own toilets have been core components in the program’s success in Bihar.
The SDGs call for progress in sanitation by 2030.
Goal 6: Ensure availability and sustainable management of water and sanitation for all.
6.2: Achieve access to adequate and equitable sanitation and hygiene, and end open defecation, paying special attention to the needs of women, girls, and those in vulnerable situations.
6.2.1: Proportion of population using safely managed sanitation services, including a handwashing facility with soap and water. Learn more.
UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) 2017-2020 Strategy
The UN-Water GLAAS strategy responds to the new demands of the SDGs and sets a course for GLAAS actions at the country level. Learn more.
WHO Joint Monitoring Programme (JMP) Report: Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and Sustainable Development Goal Baselines
Many countries lack data on the quality of water and sanitation services. This report includes estimates for 96 countries on safely managed drinking water and for 84 countries on safely managed sanitation. Learn more.
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Handwashing with soap is a simple and effective way to prevent diarrhea. Hygienic practices like handwashing maintain health and prevent the transmission of diseases.
Contaminated hands are one of the main ways diarrhea is spread.
Since diarrheal diseases are transmitted through the fecal-oral route, routine handwashing with soap can prevent the transmission of the bacteria and viruses that cause diarrhea, particularly when regularly practiced after using the toilet or changing a baby’s diaper and before preparing food.
Handwashing with soap is one of the most cost-effective investments in public health. Handwashing prevents diarrhea and a host of other infections that can be extremely costly to individuals, health care systems, and countries.
Washing hands in schools and health care facilities can have a significant impact.
It is critical to educate both parents and caregivers on the importance of correctly washing hands. For children, schools provide ample opportunities for promoting healthy habits.
Since improving handwashing requires behavior change, it works best as part of a broader package of solutions.
Handwashing with soap could eliminate nearly half of all diarrhea infections.
Without good hygiene practices like handwashing with soap, efforts to improve drinking water and sanitation will be undermined and unsustainable. The SDGs are monitoring the percentage of people with facilities in their homes to wash their hands with soap and water. Access varies immensely, from 15 percent of the population in sub-Saharan Africa to 76 percent in West Asia and North Africa.
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