Reflections on the University of North Carolina's (UNC) Annual Water and Health Conference

Participants listen to a speaker on visualizing urban sanitation service delivery during the annual Water and Health Conference. Photo credit: UNC Water Institute

The UNC’s Water Institute annual policy-meets-science exchange has become the go-to domestic knowledge-sharing forum among water and sanitation development practitioners, funders, and academia. This year USAID participated in more than 15 presentations and side events on a wide array of topics, including designing sanitation enterprises, rural water supply, and examining research’s role in driving policy and promoting change.

As USAID attendees engaged in this fertile ground for exchange and learning, we asked participants to highlight key takeaways from the conference overall and specific sessions to shine a light on some of the hot topics capturing the water, sanitation, and hygiene (WASH) sector’s attention.

Research into Policy

USAID joined the Bill & Melinda Gates Foundation and the U.K. Department of International Development in a session, “How Does Research Drive Policy and Practice in the Quest to Change Behavior, Deliver Sanitation Services, and Improve Public Health?” Audience members challenged panelists and one another to understand if and how scientific research currently drives practice and policy. An interactive “fishbowl” session had participants debating the following—how are donors applying research results to future programming? Are large donors institutionally prepared to act on critical research findings that question previous dogma? How can research be more effectively shared across sectors? What efforts can donors take to drive evidence-based programming?


Several UNC sessions featured lively discussions between WASH finance experts and practitioners related to subsidies. Determining when in the life cycle of a product, good, or service (e.g., building a latrine or subsidizing a water tariff) to implement a subsidy and who provides it is an increasing consideration for both large funders and private sector organizations. While consensus is lacking among experts on the ideal method to deploy subsidies at scale, more evidence is becoming available through randomized controlled trials and impact evaluations. Even less understood is the human behavior around subsidies—and what triggers more willingness to pay.

WASH in Health Care Facilities

WASH services are inadequate in most health care settings in resource-poor countries—this includes water supply, cleaning materials, protective gear, and safe waste disposal. These conditions can result in health care associated infections and poor outcomes due to contamination in maternity wards. More women are delivering their babies in health care facilities, so improved WASH in the health care setting is even more critical to prevent infection. Solutions being explored range from mapping health care facilities to developing tools that build the capacity of cleaning staff, such as Teach-Clean, and that quantify the costs of the environmental health services needed to provide safe and adequate care to patients.

Menstrual Hygiene Management (MHM)

The annual virtual MHM in schools conference was live-streamed again this year at the UNC conference and presentations, posters, and videos from the event are available here. An emerging body of research has explored the health and social impacts of menstrual hygiene management but much less is known about consumer preferences and how they serve as barriers or facilitators to safe MHM. Product quality appears to be as or more important than even price. Some studies indicate a potential upcoming challenge for the subsector—safe disposal of pads—in places where women appear to prefer disposable options over reusable.


The conference featured quite a bit of research on the fate and transport of sanitation-related pathogens, including modeling of the risks of leakage into the environment from different types of sanitation—latrine pits, septic tanks, and piped sewerage—and tools to help choose the most appropriate treatment option based on the microbiological makeup of the wastewater.

The Global Water Pathogen Project held a side event showcasing the tools its developed for quantifying risk of rotavirus in Uganda. The project is a consortium of more than 250 researchers compiling more than 100 chapters on the multitude of pathogens in water, their shedding/excretion rates, their transport and survival in the environment, and management risks and treatment options.

Sustaining Rural Water Services

Three different USAID activities came together to host a comprehensive discussion on water services in the challenging and water-scarce East African Lowlands region. USAID Lowland WASH presented their approach to institutionalizing asset management at Woreda Water Offices in Ethiopia; University of Colorado Boulder and Millennium Water Alliance discussed how Kenya Resilient Arid Lands Partnership for Integrated Development uses remote data collection to go beyond reporting functionality, including promoting accountability and advocating for government budgets. IRC explained how they are applying systems thinking to understand the complex factors that underpin sustainable water services through their work on the Sustainable WASH Systems Learning Partnership. The facilitator emphasized the importance of regional learning and asset management in the professionalization of water service delivery.

The End of Aid?

The closing plenary included a discussion about the role of foreign aid and whether the need for it will go away anytime soon. There was general consensus that the number of countries requiring significant development assistance is on the decline, but aid will still need to be targeted toward fragile states; those in need of humanitarian assistance; and to counter emerging threats such as pandemics, climate change, and migration. The work of development professionals and organizations will not go away, but the nature of the work and priorities will evolve to include more technical assistance, problem-solving, and investment in job creating sectors. A recurrent theme throughout the session and conference was the need to have frank discussions about programs and approaches that have not worked well—“the less successful successes” that drive us to improve and refine our approaches.

The official UNC Water and Health Conference website provides links to plenary sessions, presentations, and poster and presentation abstracts.


By Patricia Mantey, USAID Water Office, and Wendy Putnam, USAID Water CKM Project


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Patricia Mantey and Wendy Putnam
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