Water Currents: Inclusive WASH

This issue of Water Currents centers on the challenges that disabled populations and other at-risk groups commonly face when trying to access safe water, sanitation, and hygiene (WASH). To address and overcome physical, institutional, social, and attitudinal barriers to access, “inclusive WASH” refers to various programming approaches that can be deployed to better serve marginalized groups such as the elderly, disabled, indigenious peoples, and women and girls.

While inclusive WASH is often neglected as a programming priority, it is nevertheless essential for achieving universal WASH access goals, and can be realized in many instances by utilizing  low-cost and community-driven strategies. Both the U.S. Government generally and USAID specifically are committed to extending WASH access to vulnerable populations around the world. While the U.S. Government Global Water Strategy prioritizes inclusive WASH as a strategic objective, the USAID Water and Development Plan supports gender-sensitive approaches that empower women in the development and implementation of water programming.

This issue contains the latest studies and resources detailing inclusive WASH as it relates to gender, disabled groups, the elderly, incarcerated populations, and other at-risk groups.

We would like to thank WaterAid for contributing content to this issue.

In Focus

Inclusive WASH and Gender Issues
Gender Equality and Female Empowerment in WASHUSAID, August 2020. This technical brief is a tool to support Mission WASH leads, gender advisors, and implementing partners in designing strategies, projects, and activities that both improve women’s and girls’ empowerment and achieve USAID’s WASH development objectives.

Gender-Based Violence and Environment Linkages Center (GBV-ENV Center). Ending gender-based violence and securing environmental sustainability are each global priorities. These two issues are linked in many ways, across contexts, countries, and communities. This center is a platform for gathering resources and tools, mobilizing learning, and forging action.

Practical Guidance to Address Gender Equality While Strengthening Water, Sanitation and Hygiene SystemsWaterAid, August 2020. This guidance note helps to provide practical steps on how to use sector strengthening tools to empower women and shift harmful gender norms, while achieving more sustainable WASH services.

A Gender Lens into Sanitation Technology InnovationJournal of Management in Engineering, July 2020. The findings suggest more can be done to encourage and promote gender-informed thinking in research and development in the water and sanitation sector.

The Case for Gender-Transformative Water ProgrammesOxfam, March 2020. It is important to consider how age influences women’s and girls’ water and sanitation needs. In addition, with the increasing impacts of climate change, and as conflict over scarce water resources escalates, it is important to consider how women and girls will be affected differently—for example, whether such trends place them at greater risk of gender-based violence.

Gender-Based Violence and Environment Linkages: The Violence of InequalityIUCN, January 2020. In eight out of 10 households women and girls are responsible for fetching water, exposing them to the risk of harassment, sexual assault, and rape en route.

Gender Specific Vulnerabilities to Water InsecurityUniversity of Waterloo, April 2019. Outcomes of the research indicate that water insecurity among rural women and girls in sub-Saharan Africa is attributable to inequitable responsibilities around water-related tasks that invite exposure to violence, opportunity cost, disease, and female disempowerment.

Health and Social Impacts of Open Defecation on Women: A Systematic ReviewBMC Public Health, February 2019. The study indicates a significant association between household sanitation facilities and nonpartner sexual violence in India, concluding that nonpartner sexual molestation incidents were two times more common among women who practiced open defecation than women who used toilets.

Menstrual Health and Hygiene Management and Water, Sanitation and Hygiene (WASH) in Urban Slums: Gaps in the Evidence and RecommendationswH2O: The Journal of Gender and Water, March 2020. Through a review of literature, this article seeks to highlight critical interlinkages among urbanization, sanitation, and menstruation, and identify important gaps in the existing menstruation-related evidence base.

Empowerment in Water, Sanitation and Hygiene IndexWorld Development, January 2021. The Empowerment in Water, Sanitation and Hygiene Index (EWI) is a novel survey-based index designed to measure agency, participation, and empowerment in the water and sanitation sector. The EWI can be used to assess gender outcomes of a WASH intervention and to monitor changes over time.

Understanding Empowerment in Water, Sanitation, and Hygiene (WASH): A Scoping ReviewJournal of Water, Sanitation and Hygiene for Development, December 2019. 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.

Gender Equality and the Human Rights to Water and SanitationUN, March 2020. The UN recommends developing water, sanitation and hygiene approaches, programs, and policies that proactively and deliberately enable the meaningful participation of women at all stages of planning, decision-making, implementation, monitoring, and evaluation.

Menstrual Hygiene Management for Women and Girls with Disabilities in DhakaSHARE, March 2020. Increasing the literacy rate of females in slum areas can give them the confidence and space to voice their need for improved menstrual hygiene. This study also suggests other promising approaches, including changing societal views on Menstrual Hygiene Management through TV advertisements, awareness programs, and gender education for adolescents, and improving access and availability of menstrual hygiene products.

Inclusive WASH and COVID-19
Considering Disability and Ageing in COVID-19 Hygiene Promotion ProgrammesCOVID-19 Hygiene Hub, 2020. There is a significant overlap between older populations and populations with disabilities, which should be taken into account when designing and implementing inclusive COVID-19 responses.

Putting Equality, Inclusion and Rights at the Centre of a COVID-19 Water, Sanitation and Hygiene ResponseWaterAid, April 2020. This piece highlights how emergency response to the coronavirus pandemic can mitigate new and existing vulnerabilities among people affected.

COVID-19 Response: Considerations for Children and Adults with DisabilitiesUNICEF, March 2020. Inclusion of persons with disabilities in COVID-19 responses need to be deliberate and purposeful. If not explicitly included in planning from the start, including in budgeting and resource allocation, persons with disabilities risk being excluded from prevention and response measures, despite facing heightened risk.

How Can We Ensure People with Disabilities, Older Adults, Older Adults with Disabilities and their Caregivers Are Included in All COVID-19 Hygiene Promotion Programmes? COVID-19 Hygiene Hub, August 2020. Generally, inclusion of these populations in programs requires a twin track approach of mainstreaming and targeting.

What Are Some Practical Ideas for Making COVID-19 Programmes More Inclusive? COVID-19 Hygiene Hub, 2020. This article describes several simple actions to make sure COVID-19 response programs address the needs of men, women, boys, and girls in a community.

Inclusive WASH and Populations with Disabilities/Elderly Populations
Scaling Up Disability Inclusion in Water Projects: Case Study of PAMSIMASWorld Bank, January 2020. Sustainable Development Goal 6 relates not only to water and sanitation access by persons with disabilities, but also to their engagement in the management of water and sanitation. The new Environmental and Social Framework requires borrowers to look specifically at persons with disabilities as part of any social assessments.

Equity and Inclusion Programme: Experiences in Supporting Policy Implementation in CambodiaWaterAid Cambodia, November 2019. This document aims to provide a synthesis of experiences that include challenges, lessons learned, and good practices in an attempt to support the implementation of National Guidelines on WASH for Persons with Disabilities and Older People.

Are Current Approaches for Measuring Access to Clean Water and Sanitation Inclusive of People with Disabilities? Comparison of Individual- and Household-Level Access Between People with and without Disabilities in the Tanahun District of NepalPLoS One, October 2019. People with disabilities face substantial challenges to meeting their WASH needs, particularly in using services autonomously, consistently, hygienically, with dignity and privacy, and without pain or fear of abuse. These challenges are not captured through household-level data and the Quality of WASH Access questionnaire may provide a useful data collection tool.

IASC Guidelines, Inclusion of Persons with Disabilities in Humanitarian ActionInter-Agency Standing Committee, November 2019. The guidelines set out essential actions that humanitarian actors must take to effectively identify and respond to the needs and rights of persons with disabilities who are most at risk of being left behind in humanitarian settings. It includes a chapter on WASH.

Rapid Review of Disability and Older Age Inclusion in Humanitarian WASH InterventionsElrha, May 2019. This report identifies knowledge gaps in good practices and innovation for how people with disabilities and older people are included in WASH interventions in humanitarian contexts.

A Cluster-Randomized Trial to Evaluate the Impact of an Inclusive, Community-Led Total Sanitation (CLTS) Intervention on Sanitation Access for People with Disabilities in MalawiAmerican Journal of Tropical Medicine and Hygiene, April 2018. Inclusive CLTS could improve sanitation access for people with disability but requires support to households beyond that provided in this trial.

Ensuring the Availability of Water and Sanitation for Persons with DisabilitiesUN, March 2020. People with disabilities, especially those living in developing countries, encounter challenges in access to WASH, including physical, institutional, social, and attitudinal barriers. Moreover, evidence from a limited number of developing countries indicates that more than one in seven people with disabilities finds the toilet at home hindering or not accessible.

Inclusive WASH and Incarcerated Populations
Prisons and the Pandemic in Malawi: The Critical Role of WASHWSSCC, August 2020. Overcrowding and the lack of sanitary resources are heightening the risk of COVID-19 in prisons. Raising this alarm is Christopher Mhone, programs manager for Saint John of God, a local NGO in Malawi that provides services to vulnerable populations such as prison inmates.

Preparedness, Prevention and Control of COVID-19 in Prisons and Other Places of DetentionWHO, March 2020. The response to COVID-19 in prisons and other places of detention is particularly challenging, requiring a whole-of-government and whole-of-society approach.

‘Mankind Owes to the Child the Best that It Has to Give’: Prison Conditions and the Health Situation and Rights of Children Incarcerated with their Mothers in Sub-Saharan African PrisonsBMC International Health and Human Rights, March 2019. The review highlights the grave situation of children incarcerated with their mothers in sub-Saharan African prisons, underpinned by the lack of basic necessities; inadequate hygiene, sanitation, and safe drinking water; exposure to diseases in overcrowded cells; inadequate nutrition; lack of provision of clothing and bedding; and difficulties accessing pediatric care.

Intestinal Parasite Infections (IPI) and Associated Factors among Inmates of Arba Minch Prison, Southern Ethiopia: Cross Sectional StudyBMC Infectious Diseases, December 2019. Implementation of mass drug administration, education on WASH, and periodic screening of intestinal parasitic infection are very important to reduce the high prevalence of these infections in prison.

Others
Urban Water ServicesUSAID, October 2020. Urban water services must ensure targeted interventions for the underserved, poor, and vulnerable. See also the USAID Water and Development Technical Series on urban sanitation, rural water, rural sanitation, and other topics.

Assessing the Impact and Equity of an Integrated Rural Sanitation Approach: A Longitudinal Evaluation in 11 Sub-Saharan Africa and Asian CountriesInternational Journal of Environmental Research and Public Health, March 2020. Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. This study characterizes the impact of the Sustainable Sanitation and Hygiene for All approach on key program WASH indicators, and also assess if these increases in WASH coverage are equitably reaching vulnerable groups.