WASH

WASH consists of water, sanitation and hygiene, in clockwise order from top left: A woman pumps water from a handpump in her village in Sindh, Pakistan; A girl collects clean water from a communal water supply in Kawempe, Uganda; a simple hand washing setup for when there is no running water, shown in Omaruru, Namibia; school toilets at an elementary school in Boquete, Panama.

WASH (or Watsan, WaSH) is an acronym that stands for "water, sanitation and hygiene". It is used widely by non-governmental organizations and aid agencies in developing countries. The purposes of providing access to WASH services include achieving public health gains, improving human dignity in the case of sanitation, implementing the human right to water and sanitation, reducing the burden of collecting drinking water for women, reducing risks of violence against women, improving education and health outcomes at schools and health facilities, and reducing water pollution. Access to WASH services is also an important component of water security.^[1] Universal, affordable and sustainable access to WASH is a key issue within international development and is the focus of the first two targets of Sustainable Development Goal 6 (SDG 6).^[2] Targets 6.1 and 6.2 aim at equitable and accessible water and sanitation for all. In 2017, it was estimated that 2.3 billion people live without basic sanitation facilities and 844 million people live without access to safe and clean drinking water.^[3]

The WASH-attributable burden of disease and injuries has been studied in depth. Typical diseases and conditions associated with lack of WASH include diarrhea, malnutrition and stunting, in addition to neglected tropical diseases. Lack of WASH poses additional health risks for women, for example during pregnancy, or in connection with menstrual hygiene management. Chronic diarrhea can have long-term negative effects on children, in terms of both physical and cognitive development.^[4] Still, collecting precise scientific evidence regarding health outcomes that result from improved access to WASH is difficult due to a range of complicating factors. Scholars suggest a need for longer-term studies of technology efficacy, greater analysis of sanitation interventions, and studies of combined effects from multiple interventions in order to better analyze WASH health outcomes.^[5]

Access to WASH needs to be provided at the household level but also in non-household settings like schools, healthcare facilities, workplaces (including prisons), temporary use settings, mass gatherings, and for dislocated populations.^[6] In schools, group handwashing facilities and behaviors are a promising approach to improve hygiene. Lack of WASH facilities at schools can prevent students (especially girls) from attending school, reducing their educational achievements and future work productivity.^[7]

Challenges for providing WASH services include providing services to urban slums, failures of WASH systems in the months and years after installation (e.g. leaking water distribution systems), polluted water sources and the impacts of climate change. Planning approaches for better, more reliable and equitable access to WASH include for example: National WASH plans and monitoring, women’s empowerment,^[8] and improving climate resilience of WASH services. Adaptive capacity in water management systems can help to absorb some of the impacts of climate-related events and increase climate resilience.^[1]: 25 Stakeholders at various scales, i.e. from small urban utilities to national governments, need to have access to reliable information about the regional climate and any expected changes due to global climate change.