WSH 714.pdf

WSH 714 – SECTORIAL PERSPECTIVE IN WASH
WASH operation in Households
Safe drinking-water, sanitation and hygiene are crucial to human health and well-being. Safe
WASH is not only a prerequisite to health, but contributes to livelihoods, school attendance and
dignity and helps to create resilient communities living in healthy environments. Drinking unsafe
water impairs health through illnesses such as diarrhoea, and untreated excreta contaminates
groundwaters and surface waters used for drinking-water, irrigation, bathing and household
purposes. Chemical contamination of water continues to pose a health burden, whether natural in
origin such as arsenic and fluoride, or anthropogenic such as nitrate. Safe and sufficient WASH
plays a key role in preventing numerous (neglected tropical deseases) NTDs such as trachoma,
soil-transmitted helminths and schistosomiasis. Diarrhoeal deaths as a result of inadequate WASH
were reduced by half during the Millennium Development Goal (MDG) period (1990–2015), with
the significant progress on water and sanitation provision playing a key role. Evidence suggests
that improving service levels towards safely managed drinking-water or sanitation such as
regulated piped water or connections to sewers with wastewater treatment can dramatically
improve health by reducing diarrhoeal disease deaths.
Water and environmental borne pathogens have a tremendous impact on children’s health:
Diarrheal disease accounts for 1 in 9 child deaths worldwide, killing 2,195 children every day—
more than AIDS, malaria and measles combined. Though clean water can be provided at a
communal water point, it is often contaminated before it reaches a child’s mouth for consumption.
Similarly, though increasing coverage of latrines has a global health effect, it is not cost effective,
and, it is likely that the bulk of environmental pathogens for under 2 years come from dirty play
spaces, dirty hands and unclean water.
Solution
Clean Household Approach (CHA) provides an umbrella for a host of household WASH
interventions that address child health. It includes four central elements that allow households to
achieve “clean household status”:

1. Clean drinking water for children under 5 and filtered drinking water for children 6 months to 2
years of age.
2. Handwashing at appropriate times for newborn care, food preparation and before eating.
3. Clean play spaces around children, especially under 2 years of age.
4. Safe disposal of child feces, either through a latrine, garbage pit or other disposal mechanism.
WASH in Schools
Millions of children go to schools with no drinking water, no toilets and no soap for handwashing,
making learning difficult – with devastating consequences for their future.
Nearly half of all schools do not have basic hygiene services, with 1 in 3 primary schools lacking
basic sanitation and water. Children who cannot wash their hands face a greater risk of
infection and diarrhoeal disease than those who can, putting them at risk of missing more school
days.
Interventions: UNICEF supports over 100 countries in establishing and rehabilitating WASH
facilities in schools. It helps governments develop strategies and standards, create or improve
monitoring systems to track and report progress, and review budgets and coordination efforts for
greater efficiency. Along with other partners, UNICEF advocate to governments, donors and the
private sector to improve WASH services in schools, and to facilitate knowledge exchange and
learning.
WASH in Healthcare facilities
WASH in health-care facilities helps reduce the risk of infection and improves prevention and
control — crucial during outbreaks like cholera, Ebola, COVID-19 and other infectious diseases.
Without water, sanitation and hygiene services, mothers and newborns may not receive the quality
of care they need to survive and thrive. When health-care facilities are equipped with safe WASH
services, members of the community are more likely to visit them, and health workers are able to
model good sanitation and hygiene practices.

Some 1 in 4 health-care facilities do not have basic water services. Around 1 in 5 lack sanitation,
and 1 in 6 have no hand hygiene facilities and no soap and no water in toilets.
Lack of WASH facilities adversely affects health service delivery, especially for women, girls,
persons with disabilities and the elderly. Facilities with inappropriate design overly affect persons
with disabilities, pregnant women and children. This exacerbates the risk of people losing interest
to visit health facilities.
Interventions: As of 2019, UNICEF has been working in over 80 countries to improve access to
WASH in health-care facilities. Their work focuses on technical assistance to governments for the
construction and rehabilitation of WASH infrastructure, as well as on developing national
standards, policies and hygiene protocols for WASH in health-care facilities.
In partnership with the World Health Organization, UNICEF works with governments to
implement and monitor the Eight Practical Steps to universal access to WASH and the
commitments made by governments to implement the Resolution on WASH in health-care
facilities.
Deep and profound inequalities in urban areas often leave the poorest children with little or
no access to WASH services.
By 2050, 2.5 billion more people are projected to join urban populations. Access to quality WASH
services has not kept pace with this kind of growth: There were more people without basic water
and sanitation services in 2017 than there were in 2000.
Many children living in impoverished urban settlements, like slums, are deprived of their rights to
drinking water and sanitation. This has serious implications for their survival, growth and
development.
Increasing access to WASH services for the marginalized urban poor is an important frontier of
UNICEF’s work. Our Global Framework for Urban Water, Sanitation and Hygiene sets our
strategic vision for Urban WASH programming across global, regional and country levels.
Lesson Work 1: Modalities of WASH in Commercial and Public Institution

Gender Equality and Social Inclusion in WASH
Lack of access to WASH services disproportionately affects women, girls, persons with
disabilities, the poorest people and the elderly. In spite of the fact that they are the most affected
they are not actively participating in WASH governance and decision-making processes because
of a lack of confidence and skill, social norms and unequal power relations. WASH programme
designed without involving the marginalized groups may result in either abandoning or misuse of
the facilities. When people resort to unprotected water sources and open defecation, the risk of
disease outbreaks is likely to happen. This will give an additional burden on women and girls, as
traditional caretakers for the sick family members.
Lack of WASH facilities and/or unsuitable sanitary facilities in the schools, resulting in increased
dropouts of adolescent girls. Lack of menstrual hygiene management (sanitary products, separate
room to wash and change pads) overly affect girls’ education. Facilities with inappropriate design
exceedingly affect persons with disabilities, and this makes them lose interest to go to school. The
risk of gender-based violence is exacerbated by the improper location of water points and sanitary
facilities, as well as the lack of separate sanitary facilities for males and females.
Intervention: The collective work of Water for Women leads and inspires the global water,
sanitation and hygiene (WASH) sector to adopt evidence-based socially transformative practice to
contribute to eliminating inequalities and achieving sustainable positive change for all. The Fund
is committed to gender equality and social inclusion (GESI) in line with global commitments in
WASH and beyond, and further contributing to the well-established evidence base regarding the
connection between inclusive, equitable and sustainable WASH, and improved gender equality
and social inclusion outcomes.
The Fund’s GESI approach supports the ambition of the SDGs to ‘leave no-one behind’. Water
for Women recognises gender as a fundamental and globally universal dimension of inequality
and denial of rights, while also recognising other dimensions of in equality and rights, such
as disability, age, sexual and gender minorities (SGM), ethnic minorities, and people living
in extreme poverty and/or remote communities. Water for Women supports efforts to address
different forms and contributors to poverty, marginalisation and inequality.

WASH situation in Asia
Indonesia: Hand washing practices were found to be infrequent despite available facilities. Risk
factors were associated with diarrhoea due to lack of handwashing stations, minimal presence of
septic tank toilets and poor use of toilets.
Nepal: It is found that most of the people (96.3%) are using the latrine for defecation out of which
74% use improvised toilets without sharing. The handwashing with soap is limited to only 71.4%
of respondents. A study also confirms that 70.1% of people use to brush their teeth once. Nearly
64.2% of households do not use any sophisticated methods for cleaning portable drinking water.
India (West Bengal State): There are various types of water consumption and sanitation practices
patterns dominant in the urban slums of Siliguri. According to the concerned study, 733 (92.1%)
of the slum dwellers use better drinking water sources; the public tap (71%) plays a big role as the
primary source of water. A report also confirms that 54.9% of families use improved and 45.1% of
use unimproved portable water resources for food preparation and/or handwashing. There is
evidence of two-thirds of the families (65.7%) use sophisticated sanitation facilities, of which the
use of a flush facility consists of 47.5% in comparison to 18.2% using an improved pit latrine.
India: The public taps play an important role as a source of drinking water which is closely
followed by the dug wells and ponds. The use of latrines was found in relatively low households
of around 73.5%. Among all the members of the household only 66.8% use latrines, the rest 33.2%
still depend on open defecation. The hand washing practice was done by 86.5% associated with
before and after consumption of food and only 78.3% practiced hand washing in association with
feeding the child.
Bangladesh: The main source of drinking water found to be tube well among that 96% of
platforms were found to be cemented. However, the main crisis was due to problems with iron and
arsenic which make the water unsuitable. The overall WASH practices depend: First, accelerating
action by the local administration needs to be incorporated to improve water quality. Second,
various hygiene awareness programs should be conducted with the direct involvement of the
community. Third, emphasis should be given to health education to improve people’s behaviour.
Fourth, awareness through digital media should be strengthened in rural areas. defecation is found

to be burdensome causing child stunting. Well-targeted nutrition-sensitive interventions are the
order of the day to overcome the situation.
Laos and Thailand: In suburban Laos, the factors like use of household materials, types of storing
water containers and unavailability of toilets are correlated with dangerous organisms like
Escherichia coli (E. coli). The high level of E. coli in the two villages in Laos and rural Thailand
was found to be a risk factor for diarrhoeal diseases. Massive steps need to be taken for the
provision of improvised toilet facilities to reduce the burden of diseases.
Myanmar: According to research the prevalence of gastrointestinal disease was found in 83
(22.8%) households and non-disease in 281 (77.2%) households. The households focusing on non-
tube water were 6.5 times more in comparison to others in connection with the occurrence of
gastrointestinal diseases than those who use tube water.
Timor-Leste: The community-based assessment shows that factors in Timor-Leste are Soil
Transmitted Helminths (STH) infections in the area of high STH. High STH is endemic with a
poor level of WASH. Improper disposal of human excreta is associated with a major driver of STH
transmission which is reported due to poor sanitation infrastructure.
Sri Lanka: The flooding period force the ground water sources to be affected heavily and causes
diseases. The agents causing the water-borne diseases increase due to improper drainage systems
in the coastal areas, which leads to the breeding ground for dengue.
WASH situation in Sub-Sahara Africa
In spite of the numerous consequences of inadequate WASH to healthy living, most countries in
sub-Saharan Africa are still lagging behind in the provision of improved drinking water sources,
sanitation and hygiene facilities due to several constraints. These constraints can be classified
broadly into two: natural and human-related constraints. The Africa Water Vision 2025, (as cited
in the Global Public Policy Network on Water Management, 2008) identifies a number of natural
and human threats to water scarcity in sub-Saharan Africa. The major natural threats it identifies
are sub-Saharan Africa extreme climate and rainfall variability, which has been made worst by
climate change, resulting in desertification, shrinkage of some water bodies (such as the Lake
Chad) and growing water scarcity. These natural constraints have increased the challenges of
providing adequate WASH services by national governments in sub-Saharan Africa. Although the

natural constraints contribute to water scarcity in the region, there is however, a growing consensus
that human action, or inaction, presents the greatest threat in harnessing the existing water
resources for healthy living in sub-Saharan Africa. The inability to address these threats is due to
weak governance and institutional capacity to ensure that basic WASH services are accessible to
all, mediate between conflicting interests and ensure that the needs of the poor are addressed in a
sustainable way (Global Public Policy Network on Water Management, 2008).
The human-related threats, as identified by the Africa Water Vision 2025 are:
(i) inappropriate governance and institutional arrangements in managing national and
transactional water basins;
(ii) (ii) depletion of water resources through pollution, environmental degradation and
deforestation;
(iii) (iii) failure to invest adequately in resource assessment, protection and development;
and
(iv) (iv) unsustainable financing of investment in water supply and sanitation.
In addition, high levels of illiteracy and poverty; corruption in the WASH sector; poor
infrastructure provision (electricity); inadequate National Water Supply and Sanitation Policies
(NWSSP); lack of preventive maintenance of WASH facilities, cultural barriers, technical
challenges and rapid population growth of most countries in sub-Saharan Africa exacerbate the
challenges of adequate WASH provision in the region (see Ohwo, 2016; Mara et al, 2010;
Cairncross & Valdmanis, 2006).
Highlighting the importance of population growth in meeting the MDG for WASH, Bartram and
Cairncross (2010) assert that “the increase in the numbers of people with access is also being partly
offset by population growth. Even if the target is met and the proportion of those not served is
halved, neither the number of people not served nor the global burden of disease will be halved”.
This shows that rapid population growth could be a major constraint to adequate provision of
WASH services to all by the year 2030 in sub-Saharan Africa. Mara et al (2010) identified lack of
national policies as a major constraint to success in sanitation. They noted that without adequate
policies, governments in general and health ministries in particular cannot play their key roles as
facilitators and regulators of sanitation. They assert that policies are needed to transform national
institutions into lead institutions for sanitation, that increase focus on household behaviours and

community action, that promote demand creation, and that enable health systems to incorporate
sanitation and hygiene. They criticized the inadequate application of subsidy by national
governments, aid agencies and charities, as a strategy for increasing access to improve sanitation.
They observed that this approach has resulted in slow progress for two major reasons. First, the
privileged few have benefited more from the programmes because they are better informed of the
requirements for the subsidies, to the disadvantage of the more numerous poor people who are less
informed. Second, such programmes have built toilets that remain unused because they are either
technically or culturally inappropriate or the household have not been educated on their benefits.
Similarly, Sanan and Moulik (2007) reported that about 50% of toilets built by governments are
not used for their intended purpose. For instance, many toilets in India are used as firework stores
or goat sheds (George, 2008) in a country where the practice of open defecation is 44% (UNICEF
& WHO, 2015). This situation is not far from what is obtainable in sub-Saharan Africa.
Furthermore, Minh and Hung (2011) assert that one of the reasons for the slow progress in
expanding improved sanitation coverage in the world and developing countries in particular was
the lack of proper understanding of the importance of improved sanitation solution by policy
makers and the general public. They submitted that in developing countries the governments do
not see the relationship between improved sanitation and economic development, or source of
improved welfare. In addition, cost-benefit analysis has not been commonly used to justify
increasing spending on sanitation programmes. Apart from this constraint, corruption in the WASH
sector has also been identified as a major challenge for adequate WASH services worldwide and
sub-Saharan Africa in particular. For example, the Global Corruption Report, 2008, cited in the
report of the First African Water Integrity Summit (FAWIS, 2014) revealed that US$50 billion,
representing 25% of all water investment is lost every year to corruption.
WASH situation in Latin America
General trends in the Latin America region that affect the WASH service provision in the different
LAC sub-regions and countries.
Slowdown in economic growth: During the last ‘golden decade’, the LAC region experienced a
deep economic and social transformation, which lifted millions out of poverty and enlarged the
middle class. Strong economic growth – driven by both domestic reforms and a favourable global
economic environment – was responsible for this progress (WB, 2016). Complementary social

programs, made possible by growing fiscal space, helped support the poor and disadvantaged (WB,
2016). Because of sustained economic growth, all countries of the region, with exception of Haiti,
have attained middle-income status, with 9 countries in the lower middle-income group and 14
countries in the upper middle-income group. However, during the last couple of years, the LAC
region is facing a continuing decline in growth because of an external environment particularly
adverse to commodity exporters. As a result, the LAC economy did not grow in 2015 and is
expected to contract by 1 percent in 2016. The region’s growth average is weighed down by the
slowdown in important economies such as Venezuela and Brazil.
Continued high levels of inequity and poverty: Though the region achieved considerable success
in reducing extreme poverty over the last decade, its still-high levels of income and wealth
inequality have obstructed sustainable growth and social inclusion. Inequality is growing at an
alarming pace in Latin America, posing a serious risk to the fight against poverty (Bárcena, 2016).
Until recently, Latin America was well on its way in becoming a middle-class region. However,
the reality of today is that this middle-class segment is only the largest slice of the population in a
select group of LAC countries, including Brazil, Argentina, Chile and Uruguay; had the trend of
the golden decade continued, the middle class would have become the largest group of Latin
Americans by 2017. In addition, other social gains have also slowed down. For example, the
economic downturn resulted in a lower income growth for the bottom 40 percent of the population
(WB, 2016). According to the World Bank (2015), the percentage of the regional population living
in extreme poverty (less than US$ 2.50 /day) decreased from 12.2 percent in 2012 to 11.5 percent
in 2013. However, despite unprecedented inroads against poverty in LAC since the turn of the
century, about 130 million people have never known anything but poverty, subsisting on less than
US$4 a day throughout their lives (WB, 2016), 80 million of those still living in extreme poverty:
half of them in Brazil and Mexico (The Economist, 2014). The World Bank finds that all countries
in Latin America are more unequal than Turkey, the most unequal OECD country from outside the
region.
Ongoing urbanization: Latin America has a total population of 530.8 million (World Bank,
2016), of which after 60 years of rapid urban development, 80 percent reside in urban areas. By
2050, an estimated 90 percent of the population will live in towns and cities (UN Habitat 2014).
Presently, 260 million people live in the region’s 198 large cities (populations of more than 200,000

people). Estimates expect this number to grow to 315 million people by 2025. Brazil and Mexico,
the region's urban leaders, are home to 81 of the region's large cities. The ongoing urbanization
means an increasing pressure on the existing infrastructure such as for transportation, housing and
social services. At the same time, Latin America is making strong progress in the communications
infrastructure and citizen connectivity areas. The region has the world's fastest growing Internet
population, with 147 million unique visitors online (Atlantic Council, 2014).
Governance Trends (Centralization & Decentralization): In Latin America, decentralization is
strongly linked to the democratization processes initiated in the 1980s. Reforms were used as an
instrument to increase state legitimacy and democratic governance. The scope, rhythm, depth and
impact of decentralization have understandably varied significantly throughout the region. Some
public policies have been decentralized while others remain firmly in the hands of central
governments. Some countries remain highly centralized, while others have made real moves
towards genuine decentralization (Bossuyt, 2013). The levels of political autonomy enjoyed by
local governments tend to vary significantly. Countries such as Bolivia and Ecuador linked
decentralization to rather radical political and institutional transformation reforms, aimed at
empowering local actors and reducing structural territorial inequalities. Other countries proceeded
more smoothly to strengthen local governments (Paraguay), regional bodies (Peru) and existing
federal systems (Brazil and Argentina); Chile opted for retaining strong central control (Bossuyt,
2013). Bossuyt states that decentralization is not necessarily an irreversible process. Recently,
trends toward some forms of “recentralization” have emerged in different parts of the region. For
instance, in Argentina, Dominican Republic, Peru and Venezuela, municipal governments face a
cut in their competencies and resources. Another related obstacle to advancing the decentralization
agenda stems from the worldwide financial crisis that started in 2008. This has led to a significant
drop in incomes for most municipalities and deficits in the automatic transfers of resources from
the central level. The regular transfer of funds allocated to municipalities has been significantly
reduced (with 22%) in the last five years (Bossuyt, 2013). Another trend over the last couple of
years is an increased political interference from central government in municipal government
affairs in some countries of the region (Nicaragua, Bolivia and Venezuela). On the other hand, the
“social accountability” function of civil society towards local governments has recently emerged
and is quite rapidly gaining momentum across the region (Bossuyt, 2013). There has been
important progress in many countries, yet major bottlenecks still make it difficult to realize the full

potential of decentralization and local governance as tools for enhanced development outcomes.
Beyond the formal institutions, a culture of clientelism, “caciquismo” and “caudillismo” is still
structurally present, fuelled by pervasive forms of corruption (Bossuyt, 2013). In addition, most
research does not yet show an automatic correlation between decentralization and improvement of
the quality, access and equity of public services. At the same time, limited capacities in local
governments inhibit accomplishment with the full range of responsibilities tasked to them. In
parallel, new challenges have risen for local governments as a result of deepening globalization
such as the intrusion of multinational companies at local level. Despite the many challenges to
consolidate the achievements of decentralization, Latin America is in many ways a “laboratory”
for new approaches to managing public affairs at local level. The region has spearheaded
innovations in participatory budgeting (PortoAlegre, Brazil) that have gradually spread throughout
the continent and to other parts of the world (Bossuyt, 2013). Other reforms have attracted interest
from all corners of the world such as ranking systems of local performance in Brazil/Colombia;
per client-based transfers for health and education in Chile, or fighting poverty with direct transfers
to families administered by municipalities (Bossuyt, 2013).
Changes in aid landscape Globally: the traditional aid landscape has changed drastically due to
new donor entrants (China, India, Brazil and South Africa), geopolitical changes, and economic
growth trends, which have contributed to an eclipse of the relative importance of aid in comparison
to other sources of finance for development. In Latin America this has translated into in a relative
decline of Official Development Assistance (ODA) as a percentage of national income, since 2005.
The relative share of aid - as a share of the net national income - is below 1 percent in most
countries with the exception of Belize, Bolivia, Guyana, Honduras and Nicaragua. Overall, there
has been a shift away from the use of grants to increased use of loans. The shifting panorama of
the aid architecture in Latin America is further underscored by Brazil, Venezuela and Chile playing
a significant role in South -South cooperation and with Brazil taking up a donor role even beyond
the Latin America region.
Increased impact of climate change and increased environmental vulnerability: The impact
of climate change will be increasingly felt in Latin America. Climate change poses an increasingly
severe threat to the availability of water for both productive and potable use. It is estimated that by
the 2020s, the net increase in the number of people experiencing water stress due to climate change

in the region is likely to be between 7 and 77 million. The relative importance of the impact
attributed to this projection varies among the geographical sub-regions and countries. This is
compounded by other environmental impacts because of changes in land and water usage. The
World Bank states that without climate-informed development in LAC, an additional 2.6 million
people could fall into extreme poverty by 2030, as the poorest population segment are at higher
risks of losing wealth when exposed to climate-related shocks such as floods, droughts, and heat
waves (World Bank in Jamaica Observer, 2015).
WASH (Water, Sanitation & Hygiene) and COVID-19
Safely managed water, sanitation, and hygiene (WASH) services are an essential part of preventing
and protecting human health during infectious disease outbreaks, including the COVID-19
pandemic. One of the most cost-effective strategies for increasing pandemic preparedness,
especially in resource-constrained settings, is investing in core public health infrastructure,
including water and sanitation systems. Good WASH and waste management practices, that are
consistently applied, serve as barriers to human-to-human transmission of the COVID-19 virus in
homes, communities, health care facilities, schools, and other public spaces.
Safely managed WASH services are also critical during the recovery phase of a disease outbreak
to mitigate secondary impacts on community livelihoods and wellbeing. These secondary
impacts—which could include disruptions to supply chains, inability to pay bills, or panic-
buying—have negative impacts on the continuity and quality of water and sanitation services, the
ability of affected households to access and pay for WASH services and products (for instance,
soap, point of use water treatment or menstrual hygiene products) and the ability of schools,
workplaces and other public spaces to maintain effective hygiene protocols when they re-open. If
not managed, secondary impacts can increase the risk of further spreading water borne diseases,
including potential disease outbreaks such as cholera, particularly where the disease is endemic.
According to a WHO/UNICEF technical brief on WASH and waste management for COVID-19:
• Frequent and proper hand hygiene is one of the most important measures that can be used to
prevent infection with the COVID-19 virus. WASH services should enable more frequent

and regular hand hygiene by improving facilities and using proven behavior change
techniques.
• WHO guidance on the safe management of drinking water and sanitation services applies to
the COVID-19 outbreak. Measures that go above and beyond these recommendations are not
needed.
• Many co-benefits will be realized by safely managing WASH services and applying good
hygiene practices. Such efforts will prevent other infectious diseases, which cause millions
of deaths each year.
Beyond the human tragedy, devastating economics impacts are anticipated in all countries and for
the most vulnerable and marginalized people in society. Human and economic costs are likely to
be larger for Fragile, Conflict, and Violence (FCV)-affected countries and lower and middle-
income countries, that generally have limited coverage and capacity of water supply and sanitation
systems, lower health care capacity, larger informal sectors, shallower financial markets, limited
fiscal space, and poorer governance. As such, for all interventions it will be especially important
to target FCV-affected countries—home to about two-thirds of the world’s extreme poor. While it
is too early and with too many variables to quantify the economic costs of the pandemic, the costs
of inaction would be catastrophic.
Priority Areas
Action in the WASH sector is therefore critical for both containing the virus and lowering its
immediate impact and aftermath. Three priority areas are identified as part of the emergency
response:
1. Safe WASH services in health care facilities (HCFs) to deliver quality health services; protect
patients, health workers, and staff; and to prevent further transmission. The WASH in Health
Care Facilities Global Baseline Report (JMP, 2019) highlighted that one in four HCFs lacks
basic water service (affecting more than 900 million people), one in five HCFs has no
sanitation service (affecting about 1.5 billion people), and one in six HCFs has no hygiene
service. During an infectious disease outbreak, services should meet minimum quality
standards and should be separated for infected vs. non-infected patients. Support should

ensure services are not disrupted and products such as soap and alcohol-based hand rubs are
available. These services should also be available in temporary HCFs and quarantine sites.
2. Improving handwashing behavior, food hygiene, and safe water practices. Materials for
handwashing and hygiene may include provision of fixed and portable handwashing
facilities, purchase of soap and alcohol-based hand rubs, provision of water supplies for
handwashing, and point of use water treatment. Schools, workplaces, markets, transport
stations, and other areas where people gather all require easy access to handwashing facilities
and water and soap for handwashing. Proven behavior change techniques can help increase
the frequency and improve the practice of critical hygiene behaviors. Resources such as
the Global Handwashing Partnership can be tapped to mobilize private, public, and civil
society actors to support developing messaging and materials to respond to COVID-19
outbreaks in country.
3. Emergency support to secure and extend water and sanitation service provision, including:
• Rapid and low-cost water service and sanitation provision for communities, health care
facilities, and schools is critical to enable handwashing, hygiene, and disinfection. According
to UN Habitat, COVID-19 will hit the world’s most vulnerable people the most, many of
whom live in informal settlements and rural community settings. Providing quick, just-in-
time community water access points/water kiosks (including provision of soap) in unserved
urban and rural areas, and for unserved HCFs and schools is critical. This could include:
(i) provision and operation of compact water treatment plants;
(ii) construction and operation of water points and sanitation facilities to deliver water in
strategic urban or rural points; and/or
(iii) provision and operation of trucks for water delivery (bottled, sachets) and water tankers,
including adequate water storage to service operators.
• Support to water supply and sanitation (WSS) service providers to prepare emergency plans
and ensure continuity of service delivery through inter alia: provision of water treatment
chemicals and spare parts, availability of fuel for pumps and treatment, maintaining staffing

levels, providing protective equipment for utility staff and salary supplements to compensate
for the additional work-loads.
WASH Interventions for An Effective COVID-19 Pandemic Response
To respond to the COVID-19 pandemic, the World Bank Water Global Practice has developed a
menu of solutions, including concrete actions to help our client governments in their preparedness
and emergency response, and future resilience to similar epidemics.
Preparedness and emergency response: Support affected, at-risk and low-capacity countries to
secure Infection Prevention and Control (IPC) in health facilities and communities.
1. Safe water supply, sanitation and hygiene services and medical waste management in health
care facilities are essential to deliver quality health services, protect patients, health workers
and staff, and to prevent further transmission. During an infectious disease outbreak, services
should meet minimum quality standards and be separated for infected vs. non-infected
patients. Support is required to ensure that services are not disrupted and products such as
soap and alcohol-based hand rubs are available. Temporary health care facilities and
quarantine sites also need to provide these services.
2. Communication and preparedness related to handwashing behavior change and promotion,
food hygiene and safe water practices. Materials for handwashing and hygiene may
include the provision of fixed and portable handwashing facilities, purchasing of soap and
alcohol-based hand rubs, provision of water supplies for handwashing and point of use water
treatment. Schools, workplaces, markets, transport stations and other areas where people
gather all require easy access to water and soap for handwashing. Proven behavior change
techniques can help increase the frequency and improve the practice of critical hygiene
behaviors. Resources such as the Global Handwashing Partnership can be tapped to mobilize
private, public and civil society actors to support the development of messaging and materials
to respond to COVID-19 outbreaks in various countries.
3. Rapid, low-cost water service provision for communities, health care facilities and schools
that currently lack access to a reliable and safe water supply is critical to enable handwashing,
hygiene and disinfection. Providing quick, just-in-time community water access points/water

kiosks (potentially including provision of soap) in unserved urban and rural areas, and for
unserved health care facilities and schools. This would include:
(i) provision and operation of compact water treatment plants;
(ii) construction and operation of water points to deliver water in strategic urban or rural
points;
(iii) provision and operation of trucks for water delivery (bottled, sachets) and water tankers,
including adequate water storage to service operators.
4. Emergency support to water and sanitation utilities to ensure the continuity of water
supplies, enhanced monitoring, staffing levels and spare parts. Additional emergency
measures include ensuring that water utility staff have protective equipment, priority for
testing, and salary supplements to compensate for the additional workload and risk.
5. Emergency response to Fragility, Conflict, and Violence countries: The main principle of an
emergency WASH response is to ensure the consideration of water supply, sanitation and
hygiene factors at the site selection and planning stages, while also coordinating the response
closely with physical planning, public health and environmental stakeholders. The response
must adhere to the multi-sectoral needs assessment for refugee emergencies (NARE),
followed by a more detailed initial WASH rapid assessment of local WASH-related resources
in relation to the need/demand.2 This includes an assessment of water resources (quantity
and quality) for water sources and distribution options.
Mitigating secondary impacts: WASH services and products are essential for well-functioning
health care facilities and to avoid disrupting community livelihoods and wellbeing.
1. Financial support to water and sanitation utilities to monitor and support cash reserves, the
availability of water and wastewater treatment chemicals, the availability of electricity fuel
for pumping and treating water, staffing levels and routine/capital maintenance.
2. Providing technical assistance to governments to strengthen country systems including:
(i) ‘agile’ service delivery mechanisms that may turn to local private sector entities to deliver
safe water through ‘turnkey’ solutions under design-build-operate (DBO) contracts; (ii)

enhanced water quality assurance/monitoring; (iii) preparation of utility emergency plans
(absenteeism may be a serious risk); (iv) safely managing wastewater and fecal sludge; (v)
emptying latrines and safely disposing excreta; (vi) monitoring secondary impacts.
3. Financial support to beneficiaries to ensure the continuity of WASH
services including financing for fee waivers to mitigate service disruption for households and
institutions (schools, health care centers, government agencies, etc.). Ensure funding for
WASH services and related products (soap, etc.) are included in Social Protection operations
targeting poorer households. In fragile countries that lack social safety nets and wherein
fiduciary arrangements do not allow for DPOs, in-kind distributions to vulnerable populations
identified as most at risk (e.g., distribution hygiene and cleaning kits, water
distribution, etc.).
4. Ensuring the viability of critical supply chains such as for hygiene product availability in
markets (e.g., soap, disinfectant, point of use water treatment supplies etc.), as well as
import/export restrictions on critical equipment needed by utilities or households.
Building resilience against future diseases: Safely managed WASH services are needed to support
affected, at-risk, and low-capacity countries to build resilience against future pandemics, as well
as against diseases that afflict the poor in the developing world on a more routine basis, such as
diarrhea. In 2016, the WHO estimated that poor WASH practices were responsible for 829,000
deaths from diarrheal disease – equivalent to 1.9% of the global burden of disease. Cholera, an
acute diarrheal disease linked to contaminated water that can kill within hours if left untreated,
infects up to 4 million people each year, and kills an estimated 21,000-143,000 people. The spread
of other diseases, like typhoid and measles, increase precipitously in the developing world when
domestic water supply outages occur. In some individuals these diseases are fatal, and in many
others their burden leads to reduced labor productivity and wages. Where the burden is high,
repeated illnesses for family members can trap households in a vicious poverty cycle.
1. The provision of safely managed WASH services.
2. Basic WASH services and medical waste management in health care facilities are essential
for safe and quality care.

3. Basic water supply, sanitation and hygiene services in schools are essential for safe and
quality care.
4. Strengthening multi-sector, national institutions and platforms for policy development and
the coordination of prevention and preparedness, including for anti-microbial resistance.
Country Examples
The World Bank moves quickly to help countries respond to COVID-19. Below are some
examples in the WASH sector:
• In the Democratic Republic of Congo, we’re supporting a communications campaign to
ensure that people across the DRC know about the importance of handwashing and physical
distancing.
• Resources in Ethiopia have been quickly mobilized to respond to the COVID-19
emergency. Working with the Ministry of Health and the Addis Ababa Water and Sewerage
Authority, we’re working to ensure all healthcare facilities have around-the-clock access to
water. In addition, water pumps and boreholes in Addis are being replaced and rehabilitated
to provide services to those living in this dense urban area.
• A project in Sri Lanka will raise public awareness about handwashing and promote the
importance of hygiene. The information will be accessible to all affected stakeholders, using
different languages, addressing cultural sensitivities, and reaching those with illiteracy or
disabilities.
• In Haiti, we’re focusing on immediate response measures including: purchasing chlorine to
ensure that water is clean, installing handwashing stations, soap and water supply in critical
areas such as markets, health centers, orphanages, and prisons. Our support in Haiti also
includes the construction and rehabilitation of WASH infrastructure in COVID19 triage and
treatment zones in hospitals and health centers. This is in addition to ensuring safe water and
basic sanitation, including waste management disposal in healthcare facilities and quarantine
shelters. Medium-term measures including ensuring that water utilities have the required
financial and safe operational conditions to continue delivering services.

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