Girls wash their hands under running faucets in India. Every dollar invested in water, sanitation and hygiene leads to $8 in economic productivity, studies suggest. Photo by: Antony Robbins / Overseas Development Institute / CC BY-NC

There’s always that one person at the conference who stands up, takes the microphone, and makes an impassioned case to include water, sanitation and hygiene on the agenda. At World Water Week in Stockholm, there are a lot of those people. And advocates for WASH are pulling out the hard evidence to convince the rest of the room that mainstreaming these topics is the best way to achieve development goals.

Every dollar invested in WASH leads to $8 in economic productivity for a developing country, studies suggest, though some put it much higher — up to $46 for every dollar spent.

Incorporating WASH into any development program increases not just the cost-effectiveness, but the long-term effectiveness as well, according Jennifer Platt, WASH Sustainability Director at WASH Advocates.

Take the case of treatment for people living with HIV and AIDS who don’t have access to clean water or don’t have the resources to practice good hygiene.

“If they’re taking their ORTs or ARTs in the mouth and pooping it out the back end, how effective is that?” Platt said.

No one would argue that access to clean water, sanitation facilities, and hygiene knowledge is unimportant. But despite nearly 2 billion people currently living in inadequate WASH conditions, the topic is often either left off the priority list, or addressed in isolation.

“I wonder if it’s so basic it’s been forgotten,” Platt mused. “We’ve all gone into our sectors — maybe that’s one of the reasons it’s been overlooked.”

Other sectors oftentimes don’t think about the relevance of WASH to their goals, said Platt. Education implementers may not consider that kids who have to spend hours getting water miss class, or that girls might stay home when they menstruate if there are no sanitation facilities at school. Health programmers don’t always make sure to include water and sanitation in their projects, even though it means clinicians sometimes can’t even wash their hands or hospital equipment.

On the contrary, health initiatives seem to be getting more and more specific, abandoning multidimensional approaches for targeted attacks on single diseases.

Platt’s research in Nepal, Sri Lanka and Malawi showed health professionals there knew how important WASH was, but didn’t consider it their responsibility.

Ownership among health care providers would require a preventive instead of curative approach, said Platt. It would also require national leadership. She pointed to Sri Lanka as a country that seems to be doing it right — focusing on prevention in its national strategy, and integrating WASH on a policy level across multiple sectors, including health and education.

And yet even there, 48 percent of rural dwellers have no clean water, and 1 million children attend schools with no toilet or hand-washing facilities. More than 2,500 people in Sri Lanka die WASH-related deaths each year.

Other countries lag behind in terms of national infrastructure, or political leadership. Congo-Brazzaville, Nigeria and Sierra Leone don’t have a formal water policy, Sao Tome and Principe did not have the necessary laws in place, Cameroon blamed a lack of WASH initiatives on lack of someone to champion them, and 25 African countries told the United Nations Environment Program they lacked the human capacity, according to the Guardian. Eighteen African states reported being hindered by a lack of money, or difficulty accessing donor funds.

Institutionalizing WASH will require a bottom-up and top down and approach, as well as increased donor resources, said Platt.

At the local level, advocacy is critical, according to Platt. Communities have to know that they are empowered to demand access to water and sanitation as a human right, and understand who to advocate to.

Communities also need to be involved starting with project conception — a key challenge that can make the difference between a sustainable intervention and a failed one.

“The challenge in the water, sanitation, and hygiene sector is that a great deal of attention is paid to project implementation — the new ecosan toilet, the new hand-washing station, or the new arsenic-free well,” said Lisa Nash, CEO of Blue Planet Network. “But unfortunately up to half of these projects fail within the first five years, not because of poor implementation, but because no one was thinking enough about sustainability at the outset.”

Out of 55 school water programs implemented in 2005 Kenya, only five met sustainability criteria when they were evaluated three years later. All five successful schools reported having active head teachers or patrons trained by CARE, and four of them also had school management committees that were engaged on WASHissues.

It has not typically been popular to look at project failure, Platt said, but organizations realize more and more that monitoring and evaluation is essential and donors need to be convinced to fund it. WASH is gaining more attention among donors now that there is a solid evidence base about its benefits. With the growing global focus on sustainability and the environment, water management, waste disposal and other WASH-y topics will likely gain even more currency.

Implementing partners, for their part, can take several concrete steps towards making WASH a part of their operations.

Forming a partnership with an organization that does have WASH expertise is one option. Starting with basic WASH additions is another: incorporating hand washing — the easiest and most cost-effective intervention — into education, prenatal, or AIDS projects, for example. Another straightforward way to nudge into the sector is by providing household water treatment through filters, though Platt reminded education and maintenance are essential for success.

And of course the WASH sector offers great potential for private sector partnerships. Proctor & Gamble has distributed PUR water packets since 2004 as part of the company’s philanthropic efforts. Other companies are creating water filtration systems or working on hand pump maintenance. Some are turning to the possibilities of monetizing sanitation systems with waste-to-energy or waste-to-fertilizer projects.

India-based nonprofit WaterWalla sells water filtration products to slum dwellers in partnership with big Indian industrial companies such as Tata, Bajaj, and Eureka Forbes, and has partnered with a health clinic so when patients present with a water-related disease, a doctor might write a prescription for a filter.

The Acumen Fund pointed to the “enormous opportunity” for social investment to make a difference in the sector.

But this isn’t the first time the WASH sector has seen optimism and attention. The U.N. tried to ensure global access to clean water in the 1980s by ushering in the International Drinking Water Decade. The year 2005 marked the U.N.’s International Decade for Action “Water for Life.” The Millennium Development Goals picked WASH up again, with a target of halving the proportion of people who cannot reach or afford safe drinking water and halving the number who do not have basic sanitation by 2015.

“We’ve been doing WASH for so long now that we should be able to look at what’s worked and what hasn’t and why  critically — and incorporate those going forward so that we’re not having the same conversation again in 20 or 30 years,” she said.

Water, sanitation and hygiene has the potential to prevent at least 9.1 percent of the global disease burden and 6.3 percent of all deaths, according to the Centers for Disease Control and Prevention CDC reports that even if the MDG for water and sanitation is met by 2015, more than one in 10 people will still go without clean water, and a quarter of the world’s population will still live without access to adequate sanitation.

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About the author

  • Jennifer Brookland

    Jennifer Brookland is a former Devex global development reporter based in Washington, D.C. She has worked as a humanitarian reporter for the United Nations and as an investigative journalist for News21. Jennifer holds a bachelor's in foreign service from Georgetown University and a master's in journalism from Columbia University and in international law and diplomacy from the Fletcher School. She also served for four years as an Air Force officer.