WASH at Work

Trainees ready to head home with new supplies and proper  instruction in flood-ravaged Pakistan.
READY TO GO!: Trainees ready to head home with new supplies and proper instruction in flood-ravaged Pakistan.
Elizabeth Barnhart, MPH. USAID Pakistan

Describing the problems of continuing gaps in access to safe drinking water supply, sanitation, and hygiene (WASH) is a well-worn track. With over 2-1/2 billion people without access to means of safe sanitation, and more than 800 million people without access to an improved drinking water source, it is easy to believe that these problems will be with us for generations to come, even in the unlikely event that U.N. Millennium Development Goal 2015 targets for water supply and sanitation are met everywhere. The current cholera outbreak in Haiti reminds us that poor conditions for WASH can lead to a resurgence of infectious diseases previously thought to have been brought under control. But this issue of Global Waters points to a way forward, or more accurately, multiple ways forward, to move us closer to the long-term goal of universal coverage with quality services. It is clear that the WASH sector is evolving and innovative approaches give hope that dramatically accelerated gains will be possible over the next decade.

For USAID, a multiple sector development agency, WASH touches on many key objectives - such as those in health, education, livelihoods, economic development, democracy and governance, environmental protection, and gender equity. WASH is also set within the broader context of water security, which includes water resources management and productive uses of water. The multiple uses of water by consumers (for domestic water needs, animal husbandry, crop irrigation, etc.) make integrated water resources management at various levels an important consideration for WASH, especially where water supply and wastewater management are concerned. 
WASH issues are strongly linked to the three major presidential initiatives in which USAID plays a leading role – the Global Health Initiative (GHI), Feed the Future (FTF), and the Global Climate Change (GCC) Initiative.

A central focus of the GHI, is inadequate access to water for household needs, both in quantity and quality. That issue, coupled with unsafe sanitation and hygiene, is responsible for an estimated 90% of the burden of diarrhea among young children, killing 1.5 million children less than five years of age each year. It is estimated that between one-third and one-half of these deaths could be prevented by known, targeted interventions, such as those being promoted through enterprise development for point-of-use water treatment, improved sanitation access, and the facilitation of handwashing, as evidenced in our article on WaterSHED-Asia. The benefits do not accrue to children alone, but also to better health and productivity for all members of a household. Indeed, the World Health Organization estimates that the single largest cost benefit of improved rural drinking water supply is the reduction in time that women need to spend gathering water. Finally, beyond cholera and infectious disease risk mitigation, improved WASH has enormous benefits for the care and support of people living with HIV/AIDS.

Feed the Future (FTF) has multiple water links, particularly through water productivity. The major connection for WASH, however, is through improved nutrition and food utilization, one of the major objectives of FTF. The role of WASH in improved nutritional status is well documented, especially for young children, whose repeated bouts of diarrhea can cause stunted growth and brain development, as well as lowering resistance to other diseases. If the child does not die from acute diarrhea, s/he may well die from pneumonia as a consequence of chronic malnutrition. 
Global climate change, associated with increased floods and droughts, threatens to negatively impact existing water and sanitation services and reduce future gains in access and service quality. Climate change is best understood as an additional factor in a complex network of interactions. Major changes in policy and planning are needed to safeguard future investments. Adaptation measures will need to be implemented now to avoid severe service disruptions in the future. Resilience to future variability depends upon drinking water and sanitation management changes for the highest risk regions.

Beyond the initiatives, WASH cuts across other development sectors, as already noted. But a common thread across all WASH activities is the need for the effective application of technology and hardware, behavior change and promotion, and an enabling environment (including policy, governance, and financing) that allows these efforts to be sustained. How these are blended for different objectives depends on a given setting. For example, the article in this issue on the West African Water Initiative (WAWI) highlights the important progress being made in Community-Led Total Sanitation, an approach to sanitation improvement that relies much less on subsidized construction and much more on triggering fundamental shifts in normative behavior away from open defecation. The role of partnerships - with local government, national governments, utilities, the commercial private sector, and philanthropic organizations - is also critical, since donors' resources will most often be inadequate in any given setting to do all that is required. This issue of Global Waters highlights several different ways in which partnerships like WAWI and the Sustainable Water and Sanitation in Africa (SUWASA) project promote both synergy and sustainability.

WASH has received renewed attention by the current U.S. Administration. Secretary of State Clinton's World Water Day speech in March 2010 kicked off efforts to more clearly define our short and long-term objectives and goals for WASH. Work is underway to describe these within a forthcoming comprehensive USAID water strategy, which was clearly requested under the Paul Simon Water for the Poor Act. We welcome your continued interest in WASH and your feedback on our work.

Jim Franckiewicz, Water Team Leader
Bureau for Economic Growth, Agriculture, and Trade, USAID

John Borrazzo, Maternal and Child Health Division Chief
Bureau for Global Health, USAID

Please send your comments & suggestions to: waterteam@usaid.gov

Last updated: September 30, 2013

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