Closure of Europe and high-income countries in peacetime may be unprecedented, but the war against preventable diseases such as COVID-19, cholera, polio, measles, and Ebola has long been raging for the 3 billion people who lack basic hand-washing facilities in their homes.
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Nearly three-quarters of the populations in the poorest countries have no hand-washing facilities with soap and water. These people, already fighting poverty, exclusion, and discrimination, do not have the luxury of stockpiling basic commodities, of battening down the hatches, of social distancing — 30% of people in the world’s urban areas live in slums. And whether or not their education is postponed, nearly 900 million children in 2016 did not have a basic hygiene service at their school in any case.
Similarly, 1 out of 6 health care facilities globally have no hygiene service, meaning they lack even the most basic hand-hygiene facilities at points of care. This is a pretty appalling reality in the face of individuals being asked to heed public health officials’ advice to self-protect — in public and at home.
Many of those 3 billion people live in South Asia and sub-Saharan Africa, whose populations account for 85% of the world’s poor and where health systems are more fragile and lack funding and trained personnel. Worse still, many of those 3 billion are the most vulnerable among us: people with disabilities, the elderly, women and girls, displaced people, Indigenous people, and those living in the hardest-to-reach rural areas.
While the international community is beginning to respond to calls for assistance to support these regions’ capacity, the worry is that after coronavirus-related motivation has passed, support will not be sustained.
While breaking human transmissibility of the new virus comes down to the practice of good hygiene — as behavioral scientists will concur — the solution is not as simple as the provision of infrastructure and a bar of soap. Hand-washing compliance is driven by a complex interdependence of factors. Investments in promoting hand hygiene — coupled with sanitation and water — must be for the long haul.
Since 1995, the London School of Hygiene & Tropical Medicine has been collecting evidence that hand-washing with soap is highly effective against diarrheal diseases. Likewise, actors in the water, sanitation, and hygiene sector — under the leadership of governments and the international community and with the support of the private sector and civil society organizations — have launched successful campaigns to inculcate personal and lasting hygiene habits. Yet, we have still failed to prioritize adequate financing at the scale needed to attain Sustainable Development Goal 6.2, which calls for providing everyone in the world — especially girls, women, and other vulnerable people — with access to adequate and equitable sanitation and hygiene. Coupled with the threat of a global hygiene pandemic, this is an outrageous and preventable failure.
According to a recent report by the United Nations, even though many countries have national plans that detail what their water, sanitation, and hygiene infrastructures should be, less than 15% reported having sufficient financial resources to implement these plans. Moreover, on the current trajectory, it will take until 2043 to achieve universal access to basic sanitation and well into the 22nd century to reach the SDG target of safely managed sanitation. Meeting targets linked to hygiene and normalizing hygienic behavior may take even longer.
How can we accelerate progress?
In April 2019, the Sanitation and Water for All partnership convened its fifth Sector Ministers’ Meeting in Costa Rica. Attended by a record 55 government ministers from all over the world, it showed the increased political prioritization of the sector and the recognition of the need for international cooperation and coordination — a significant step forward. Yet the common bottleneck for many attending ministers was access to consistent finance that would allow them to put in place not only the infrastructure to provide access to WASH services, but also — and most importantly — the systems, policies, plans, institutions, budgets, and knowledge to ensure the sustainability of services and infrastructures during and outside times of emergency such as this one.
These ministers understand that investment in sanitation and hygiene is a building block to sustainable health, gender equality, and education — and vice versa. They are also acutely aware of the linkages of WASH investment with climate change. We know, for example, that inadequate access to clean water and sanitation facilities contributes to the persistence of many deadly infectious diseases. We also know that girls are far more likely to go to and stay in a school with adequate menstrual hygiene facilities and that with proper toilets in schools, fewer students will get sick and miss out on their studies.
Therefore, in line with U.N. Secretary-General António Guterres’ call to align existing sanitation programs and projects with the 2030 Agenda for Sustainable Development, we too recognize the lack of urgency for sustained financing for this lagging SDG. The funds of one donor attract those of the next and, importantly, will unleash domestic resources and private sector investments. Existing stalwart donors — Sweden, Norway, Switzerland, Australia, the Netherlands, the U.S., the U.K., and the Bill & Melinda Gates Foundation, to name a few — remain committed to the 2030 goals. But, in addition, concerned governments need new partners that are committed, reliable, and ready to pledge up to the very last mile.
The Water Supply and Sanitation Collaborative Council is currently working to explore a new global fund that will provide governments with catalytic funding to finally tackle sanitation- and hygiene-related disease inequality. Sanitation and Water for All is also organizing a Finance Ministers’ Meeting to ensure the highest level of financial decision-makers understand the connections that sector ministers are all too aware of. Finance is the key to everything, including how much countries are prepared for this and the next public health crisis.
We, with our partners, are acting now, catalyzing change, and scaling up high-level commitment for the long haul, so that collectively, we leave no one behind.