Strengthening inclusive WASH systems for health

Safe water, sanitation and hygiene (WASH) is critical in public health. There is growing evidence that millions of people globally lack adequate WASH services and consequently suffer from or are exposed to a multitude of preventable illnesses. Lack of safe WASH services not only have adverse socio-economic and cultural impacts on people’s lives, but also weaken health systems and threaten health security at large.

While there are significant efforts from governments and civil society to strengthen, scale up and sustain inclusive and resilient WASH services, it is yet to explore how people’s health, their social-wellbeing and future resilience benefits in different socio-cultural, economic and political contexts. More attention is needed to improve access to WASH services in healthcare facilities, schools, families and public places and harness the community engagement toward Universal Health Coverage (UHC).

Provision of safely managed and sustained WASH services can greatly contribute to better health, nutrition and education in the families and communities. Shifting the locus of WASH services from infrastructure delivery, it is high time to establish inclusive, sustainable and resilient WASH systems where people’s voiced experiences, needs and choices are socio-culturally addressed in local policies, strategies and interventions.  

More significantly, WASH-related diseases and risks are wide-ranging, and these are exacerbated by a range of factors such as climate change, population growth, migration and urbanization. The infectious diseases and risks, among others, include diarroheal disease, neglected tropical diseases, maternal and neonatal sepsis and infections from unsafe healthcare waste management.

Undoubtedly, the health risks will have profound impacts on people’s social well-being and their quality of life. At the individual level, it undermines dignity and personal safety with the prevailing fear, anxiety and stress.  In the healthcare facilities, healthcare seeking behavior, safety and morale of the service providers are largely affected due to the poor provision of WASH services.   

According to WHO, 42 percent of healthcare facilities lack hand hygiene facilities at the point of care and 40 percent do not have systems to segregate waste around the world. Good hand hygiene is one of the most effective ways to reduce healthcare-associated infections and can reduce the risk of diarrhoeal diseases. Compared to hospitals, smaller facilities like clinics, health centers and health have limited access to water and sanitation services.

Therefore, integrating WASH into health systems can increase synergies and impacts on health programs such as maternal, neonatal and child health, nutrition, neglected tropical diseases, infection prevention and control, and many others. Therefore, such an integration is more likely to reduce the burden of multiple diseases and help break the vicious cycle of disease and poverty. Understandably, infectious diseases are most common among poor and marginalized populations having limited access to safely-managed WASH services.

Among WASH in health initiatives, integrating hygiene behavior change into routine immunization is a historic progress in Nepal. With the technical support from WaterAid Nepal and other implementing partners, hygiene promotion through routine immunization initiative is a nationwide scaled-up model of integrating hygiene behavior change in health systems that aims to empower mothers of children under 15 months of age in adapting key hygiene behaviors. With this intervention, evidence suggests that there is significant reduction in diarrhea and other WASH-related diseases.

Additionally, poor management of menstrual health and hygiene has a negative impact on adolescent girls and women. Still, many girls have to miss school due to menstrual cramps, heavy bleeding and fear of leakage. Therefore, a comprehensive package of WASH services is necessary for better health and education outcomes.

We continue to face healthcare waste that exposes health care workers, waste handlers, patients and their families and the community to preventable infections, toxic effects and injuries. There are critical needs of ensuring safe waste management practices in hospitals and healthcare facilities by promoting WASH in healthcare facilities in partnership with other technical agencies and relevant experts. 

Considering the critical needs of WASH in urban areas, city-wide inclusive sanitation (CWIS) is gaining priority in recent years. Recently convened ‘National Citywide Inclusive Sanitation Conclave 2023’ offered a good platform for stakeholders to share their experiences and learning in the area of WASH, and advocate for local governments to invest more in addressing WASH-related issues and challenges.

As we see, there is a growing emphasis on the sustainability of WASH services, including the need to promote community-led approaches to WASH service delivery. Despite some remarkable progress, there is an urgent need to significantly increase political commitment and ownership to deliver reliable, resilient and inclusive WASH services at scale. More concerted efforts are needed to strengthen multi-sector engagement and partnerships to increase investments in the area of WASH systems strengthening for better health outcomes at all levels.

The author is a health policy analyst