Broadening understanding of water, sanitation, and hygiene interventions

Author: Kara Kelly

Research recently published in Wiley Interdisciplinary Reviews analyzes the challenges and advancements in the Water, Sanitation, and Hygiene (WASH) field, underlining its crucial impact on global health and development.

When assessing the impact of WASH programs, the metrics used to evaluate success usually focus on water quality improvement, with the impact of interventions being over-represented.

“Such a blind spot has major implications for measuring the success of larger initiatives like the U.N.’s sustainable development goals (SDGs) and the design of future WASH programs,” says Pulte Institute Evidence and Learning Associate Director Danice Brown Guzmán, one of the study's authors. (Guaranteeing equitable access to safe water by 2030 is SDG 6.)

Water insecurity is a significant health burden for billions of people worldwide, accounting for 3 percent of global deaths annually. It has a pronounced impact on children under five in sub-Saharan Africa. And despite the billions invested in WASH projects, studies have found no significant impact on child growth and mixed results on reducing diarrhea, the researchers say. Poor access to WASH facilities contributes to these effects.

That’s why the team—which includes Keough School faculty member Ellis Adams and the University of Miami’s Justin Stoler, in addition to Guzmán—advocates for a broader evaluation criterion and new ways to address WASH practices and socioeconomic and safety challenges.

They call for measures to assess menstrual hygiene experiences and address reproductive health challenges exacerbated by inadequate WASH services. They also note a link between WASH access and violence, particularly gender-based violence, noting that such factors are usually overlooked when considering the impact of WASH programs.

“Water-quality data continues to drive the narrative of what safe water means without considering other elements like gender disparities and mental health,” Guzmán says. “That’s why we’re advocating for a multi-indicator, a dashboard-type approach to capture the full spectrum of WASH impacts.”

The team credits advancements like the Household Water Insecurity Experiences (HWISE) scale as a step forward because it focuses on disruptions to daily activities and emotional well-being. They also stress the importance of “decolonizing” WASH interventions and embracing community engagement to better understand the barriers communities face.

As they argue for a paradigm shift in how WASH projects are monitored and evaluated, the researchers say that addressing WASH insecurity requires understanding and overcoming structural, behavioral, and institutional barriers. They also highlight the interconnectedness of various resource insecurities, such as food, water, and sanitation, and their compounded effects on health and well-being.

Overall, they paint a picture of a sector at a crossroads, with traditional approaches to improving water and sanitation access no longer sufficient to meet the complex needs of vulnerable populations.

“By showcasing the wide-ranging impacts of WASH projects and their transformative relationships with other challenges related to food insecurity, health outcomes, and other issues,” Stoler says, “we hope to attract financing from global institutions to ramp up WASH projects and make global safe water a reality.”

The research study also generated a policy brief and a comment in The Lancet Global Health. Watch Danice Brown Guzmán’s overview of the research study here.