WASH and Behaviour Change – Thought Piece

Water, sanitation, and hygiene (WASH) are fundamental to human development and wellbeing. Nearly 90% of diarrheal disease – one of the largest causes of morbidity and mortality in children under five in low and middle-income countries – has been attributed to suboptimal WASH and kills more children than HIV, malaria, and measles combined.  The 2030 Agenda for Sustainable Development called for ‘ensuring availability and sustainable management of water and sanitation for all’ under SDG 6 and established ambitious new indicators for WASH services under targets 6.1 and 6.2. The World Health Organization /United Nations Children’s Fund (WHO/UNICEF) Joint Monitoring Program (JMP) for water supply and sanitation estimated that, in 2015, 663 million people lacked improved drinking water sources and 2.4 billion lacked improved sanitation facilities.  Fast forward and in 2020, The JMP report – Progress on household drinking water, sanitation and hygiene 2000 – 2020 – highlights that in 2020, 1 in 4 people still lacked safely managed drinking water in their homes and nearly half the world’s population lacked safely managed sanitation.   

The COVID-19 pandemic has highlighted the urgent need to ensure everyone can access good hand hygiene. At the onset of the pandemic, 3 in 10 people worldwide could not wash their hands with soap and water within their homes. Some progress towards achieving universal access to basic WASH services has been made – between 2016 and 2020, the global population with safely managed drinking water at home increased from 70 to 74%; safely managed sanitation services grew from 47 to 54%; and handwashing facilities with soap and water increased from 67 per cent to 71 per cent.3

Nepal has made considerable efforts to improve the water supply and sanitation (WASH) situation in the country over the last few decades, by formulating and enforcing several WASH policies, guidelines and acts. For example, the Nepal Health Sector Strategy (2015-2020) and the Multi Sector Nutrition Plan (2018-2022) both emphasise the importance of collaboration with the WASH sector to promote hand washing with soap at critical times, safe drinking water, open defecation free (ODF) communities and water safety plans. Nepal has also made tremendous progress on improving several key WASH indicators, for example basic drinking water services now reach 95% of households and basic sanitation services now reach 79% of households.  

Five years into the SDGs, the world is not on track to achieve SDG targets 6.1 and 6.2. If current trends persist, billions of children and families will be left without critical, life-saving WASH services. Achieving universal coverage by 2030 will require a quadrupling of current rates of progress in safely managed drinking water services, safely managed sanitation services, and basic hygiene services. Accelerating WASH coverage will require prioritization at the highest levels of decision making by international agencies, governments, civil society and the private sector.  

WASH interventions aim to prevent and control transmission routes of bacteria, (e.g., Shigella, E. coli) viruses (e.g., cholera) and parasites (e.g., Cryptosporidium, soil transmitted helminths) to new human hosts.,,, Data suggest that WASH interventions can be highly cost-effective. Behavioral change is an essential component of WASH programs to improve household’s hygiene and sanitation practices. WASH education or promotion can act as the means to create demand for sanitation and thereby increase coverage., WASH promotion is aimed at changing specific WASH behaviors. WASH education or promotion is an effective solution for reducing poor sanitation-related diseases due to enteric pathogens, especially diarrheal diseases.,

 Clasen T, Schmidt WP, Rabie T, Roberts I, Cairncross S. Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ. 2007;334(7597):782. pmid:17353208

 Cronin AA, Shrestha D, Spiegel P, Gore F, Hering H. Quantifying the burden of disease associated with inadequate provision of water and sanitation in selected sub-Saharan refugee camps. Journal of Water and Health. 2009;7(4):557–68. pmid:19590123

 Esrey SA, Potash JB, Roberts L, Shiff C. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ. 1991;69(5):609–21. pmid:1835675

 Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM Jr. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005;5(1):42–52. pmid:15620560

 Bartram J, Cairncross S. 2010. Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med. 7(11):e1000367. doi:10.1371/journal.pmed.1000367.

 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]).

 WHO . Guidelines on sanitation and health. https://www.who.int/water_sanitation_health/sanitation-waste/sanitation/sanitation-guidelines/en/. Accessed February 4 2019.

 Peal, A, Evans, B, van der Voorden, C. Hygiene and sanitation software: an overview of approaches. Water Supply and Sanitation Collaborative Council. https://sswm.info/sites/default/files/reference_attachments/PEAL%202010%20Hygiene%20and%20Sanitation%20Software.%20An%20overview%20of%20approaches.pdf. Accessed February 4 2019.

 Dreibelbis, R, Winch, PJ, Leontsini, E, et al. The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health. 2013;13:1015.

  Pruss-Ustun, A, Bartram, J, Clasen, T, et al. Burden of disease from inadequate water, sanitation and hygiene in low-and middle-income settings: a retrospective analysis of data from 145 countries. Trop Med Int Health. 2014;19:894-905.

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