How to make WASH projects more inclusive

ALICANTE, Spain — Marginalized groups — whether women and girls, people living with disabilities, older adults, or those from different cultures and religions — can often be excluded from accessing water, sanitation, and hygiene facilities.

A lack of WASH access can mean people don’t realize their full potential, according to Gebe Ayele, senior program adviser at Living Water International. “It has an unprecedented effect on their health, on their cognitive development, on their physical development, and on their well-being,” he said.

Often, people are unable to access the services because of infrastructure limitations. For example, an inaccessible path to a latrine could mean a person with a disability is unable to reach it, or shared toilets without latches or doors could put women at heightened risk of sexual assault.

Limitations to WASH access can also be attitudinal and institutional.

“Even when facilities are designed to be inclusive, people might still be unable to access them if they are discriminated against because of their gender, caste, age, disability, social status, or sexual orientation,” said Martina Nee, equality and inclusion adviser at WaterAid. “Some groups, such as prisoners, refugees, and sex workers, are particularly stigmatized.”

Social stigma can also play out in the exclusion of certain groups from institutional policies and procedures, said Sophie Van Eetvelt, innovation manager at Elrha, a charity dedicated to improving humanitarian outcomes through research and innovation. “These could exist within humanitarian organizations and manifest in a number of ways, such as a rapid assessment that doesn’t capture information on disability, or a companywide approach that doesn’t prioritize or allocate sufficient resources to including people with disability in WASH.”

Regardless of the barriers, the resulting exclusion stands in the way of progress toward achieving Sustainable Development Goal 6 — access to water and sanitation for all — as well as impacting a person’s dignity, well-being, and access to opportunities.

But there are steps WASH organizations can take to make their services more inclusive.

1. Consult affected populations about WASH implementation and management

Prior to the rollout of WASH facilities, including people from marginalized groups in decision-making processes is imperative, experts said.

“If marginalized people are included in the decision-making and problem-solving process, the solutions better meet their needs, preserve their rights, and are more likely to be sustainable,” Nee said. “This requires a system-strengthening approach, which takes into account institutions and authorities; policies and processes; resources and finances.”

Organizations can also take steps to make sure groups and their concerns are represented in public decision-making. For example, WaterAid runs a women’s leadership initiative in Cambodia as part of its sustainable WASH program in a bid to address the lack of meaningful participation of women in WASH governance there.

LWI encourages women and people with disabilities to be part of local WASH committees to help in the management of facilities beyond their initial implementation. “We involve them in program design, need identification, planning, implementation, and monitoring and evaluation. That is an intentional effort to influence the program and address their needs,” Ayele said. “The program is not ours. The program is theirs.”

Sarah Jewett Goddard, associate at M Booth Health, a health communications agency, said inclusion at an early stage means infrastructure can be designed with their needs at the center. “Other ways women can influence decision-making include community organizing, forming women's groups and sanitation committees, and working with local WASH organizations to develop solutions driven by the community,” she said.

2. Partner with representative organizations

Implementing NGOs should look to collaborate with local organizations that represent those who might be marginalized to help identify barriers and solutions.

In Kampong Chhnang province, Cambodia, WaterAid works with a local NGO, Phnom Neang Kangrei Association, to run participatory scoping studies with marginalized groups to understand their barriers to WASH services. And in Indonesia, German charity Arbeiter-Samariter-Bund has formed partnerships with organizations for people with disabilities to find out about their experiences accessing WASH services prior to the 2018 Sulawesi earthquake and tsunami.

“ASB is learning from their ... partners who have expertise in disability inclusion and working with communities affected by crisis, and in turn the [partners] are increasing their skills in gathering evidence and understanding barriers,” Van Eetvelt said.

3. Generate evidence

Such collaborations will help generate more insights about the barriers that marginalized groups can face in accessing WASH and can inform responsive strategies. Despite WASH being a human right for all, there is an overall lack of evidence on inclusion of people with disabilities, Van Eetvelt said. Without such evidence, it can be difficult to make the case for policy changes and investment.

In Uganda, WaterAid’s SusWASH program conducted an accessibility and safety audit in 49 schools, in partnership with Uganda National Action on Physical Disability, to gather evidence to shape policy and strategies.

The study found that WASH facilities in more than half the schools were not accessible and safe for teachers and learners with disabilities. It was used to advocate for enforcement of laws and accessibility standards within schools and informed a new female-friendly toilet design, which has been piloted in five schools across.

In Pakistan, menstrual hygiene management indicators are also included as part of an annual school survey by the government of Sindh province. This helps to track the number of schools that still lack menstrual hygiene management facilities and identify where investment is needed.

Van Eetvelt recommended the humanitarian community also work to share its experiences and lessons learned around this topic.

4. Make inclusion a formalized part of program design

LWI’s program design and quality standards documents have recently been revised to focus on inclusiveness, Ayele said. Making the consideration of different populations’ needs a routine part of project rollout helps to ensure that facilities are inclusive from the start and cater to everyone.

With the help of the revised documents, Ayele said, the construction of WASH facilities in schools in Zambia and Haiti better considered the needs of people with disabilities from the outset. “They provided a ramp and a separate room for people with disabilities,” he said. Taps, which are easier to use, were also installed instead of hand pumps, and separate facilities, including showers, for women and girls were installed to allow for privacy.

Van Eetvelt recommended organizations look to the Humanitarian Inclusion Standards, as well as the Inter-Agency Standing Committee’s Guidelines on the Inclusion of Persons with Disabilities in Humanitarian Action, for further support in putting inclusion into practice. These may also be of use when crafting internal program design documents.