Co-author:Sophie Durrans, Research Uptake Officer at London School of Hygiene & Tropical Medicine
A child who is stunted early in life – who fails to grow as tall as expected for their age – often has reduced physical and mental development. Water supply, sanitation, and hygiene (WASH) influences a child's growth in multiple ways. Evidence across low and middle-income countries demonstrates that higher open defecation rates are associated with stunting and higher overall incidence of poverty.
Women and girls are particularly affected by the lack of safe and accessible water, sanitation and hygiene (WASH). They suffer during menstruation and childbirth, and also carry the burden of hours spent collecting water when is it not easily accessible, causing them to miss school and risk rape and harassment. To address this, women and girls are emphasized in Sustainable Development Goal (SDG) #6: “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.”
While anecdotal evidence is important — and well known — it is critical to also collect data and indicators to quantify the problems, to sensitize and inform stakeholders, and ultimately, to find solutions. However, we are struggling with a global lack of monitoring to collect such data.
Today, on World Water Day, we are humbled by the fact that over 663 million people on the planet still live without access to safe drinking water; 2.4 billion people lack access to basic sanitation services, such as toilets or latrines. With these challenges persisting around the world despite decades of hard work in the water and santiation sectors, are we at a point where we need to take a step back from current solutions and practices and do business differently?
The new Water Supply, Sanitation, and Hygiene Poverty Diagnostic (WASH PD) initiative suggests exactly that.
New findings from the WASH PD initiative (led by the World Bank Water Global Practice in collaboration with Poverty, Governance, and Health, Nutrition, and Population) for the first time advances our understanding in a systematic manner of the relationship between poverty and WASH at the country level. Our deep analysis of 18 countries—across six regions—provides us with new evidence of realities that must be acknowledged, and shows without a doubt that we must work together across sectors if we are to find solutions with sustained impacts on the ground.
Over the last few years, the international community has been busy establishing new indicators for the Sustainable Development Goals (SDGs), which officially replaced the Millennium Development Goals (MDGs) for the period 2015-2030. SDG #6: Ensure access to water and sanitation for all, seeks to reduce the incidence of malnutrition, communicable diseases, and inequities that are directly related to lack of access to improved sources of drinking water (affecting 663 million people worldwide) and sanitation (which 2.4 billion people still lack). This new goal implies a commitment by countries to monitor and report on their progress, similarly to what was done for the MDGs, but with much more detail.
Under the Millennium Development Goals (MDGs), countries were requested to report the coverage of water and sanitation, distinguishing between “improved” and “unimproved” coverage. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), established specific indicators for each, using definitions that could be captured with information from standard household surveys, which typically rely on self-reported questions on access to services collected from a nationally representative sample of households.
Richard H. Thaler is a world-renowned behavioral economist and professor of finance and psychology. Recently, he was interviewed by The Economist. The discussion covers some of the fundamental studies in the field, like “save more tomorrow” which encourages people to save more by signing up to increase their savings rate every year and auto-enrollment for pensions that have drastically increased employee participation in pension funds.
Thaler also suggests, in the interview, that behavioral economics has the ability to influence human behavior for both good and bad. He argues that much of what behavioral economics does is remove barriers. The goal is not to change people but to make life easier. However, that idea can be skewed by organizations or individuals looking to capitalize on the biases of people. Whenever he is asked to sign a copy of his book Nudge, he writes “nudge for good” which is a plea, he says, to improve the lives of people and avoid insidious behavior.
The list of ways companies nudge behavior is endless, and I would love to hear more examples from you all in the comments section. In the meantime here are a few- I’ll let you judge which ones “nudge for good”:
Some thoughts on the areas of concern in the report:
The focus on ‘leaving no one behind’ is spot on. It is easy to stack up impressive WASH numbers if one ignores the poorest and the most vulnerable in communities. Safe sanitation and hygiene need to be universal for health benefits to accrue to communities. Within WASH, sanitation is specifically complex, sometimes also called a ‘wicked problem’ – a challenge foremost, of inducing lasting behaviour change. The very nature of careful social engineering required to bring about this behaviour change seems to run contrary to some of the factors that make an intervention scalable – an ability to standardise inputs and break programme components down to easily replicable bits.
Within the broad basket of ‘service delivery’ interventions, WASH is one of the trickier sectors when it comes to measuring sustained impact, especially at scale. Naturally then, ICAI find that while DFID’s claims of having reached 62.9 million people are broadly correct, it is very hard to establish if the benefits are sustained. Therefore, the results reported remain at the ‘output’ level and that is what ICAI ends up assessing, even though what they set out to do is an ‘impact’ review. While the report speculates on sustaining benefits beyond the 2011-15 period, I wonder whether those that accessed the programme in 2011-12 continued to experience any benefits in 2015.
The link with government systems, in terms of implementation, monitoring and sustenance remains unclear: another typical WASH issue. Barring say, India, (and this is true especially in sub-Saharan countries, government WASH budgets are highly inadequate. A lot of the work that happens is funded by donors and this implies that monitoring and maintenance happens outside the official system. Achieving local ownership in such a context is a challenge.
ICAI finds it difficult to assess value for money (VfM) in DFID’s WASH programmes. On one hand, it finds that there isn’t enough competitive procurement, but also there is a lack of established metrics and benchmarks to analyse VfM. Following DFID’s own 3Es framework, an Economy and Efficiency analysis should be possile across the portfolio, and as far as I can tell, is rapidly being developed in the sector, and within DFID. However, partly as a consequence of the lack of ‘outcome/impact’ data, cost-effectiveness studies are likely to remain a challenge. This work by an OPM-led consortium should be particularly relevant in improving VfM analysis across the sector.
David Njuguna, a mentor for BBC Media Action Kenya, looks at how a volunteer-run local radio station is helping prevent cholera in Kenya.
Last year Kenya was facing a devastating cholera outbreak. It started in the capital, Nairobi and by June 2015, a total of 4,937 cases and 97 deaths had been reported nationally.
According to public health officials, the spread of cholera in Nairobi particularly affected people living in slums. Frequent bursting of sewer lines, poor sanitation facilities and heavy rains played a major role in the outbreak. Poor hygiene practices – such as not washing hands before eating or preparing food – also contributed to the spread of disease. The outbreak eventually petered out, but the environment and practices that contributed to the spread of cholera continue to pose a threat.
In a quiet courtyard, away from the hustle and bustle of Nairobi’s Kawangware slum, a community radio station was planning a response.
Mtaani Radio, run by a team of volunteers, was a hive of activity when I walked into their studio last week. They were recording content for ‘WASH Wednesdays’, a show looking at ways listeners can improve their health and hygiene. The show, reaching over 100,000 people in the Kawangware community, was just about to start.
Water covers 70% of Earth’s surface, but if you live in Sana’a, Sao Paolo, California, or the many other areas where drought or chronic water scarcity has affected daily life, you know that abundance can be relative.
This image from the US Geological Survey shows that only a tiny fraction of Earth’s water is the accessible freshwater we need to live, grow food, sustain the environment, and power our cities and jobs.
Growing cities and populations and a changing climate are placing unprecedented pressures on water. According to the World Economic Forum, water crises are among the top risks to global economic growth. For at least 650 million people, even the water they are able to find is unsafe.
But this also offers an opportunity to provide safer water and better manage our water resources for a more resilient future.
This year, #worldwaterday focuses on the connection between water and jobs, and these connections primarily fall under two categories: productivity and sustainability.
The study found that globally current levels of financing are likely to cover the capital costs of achieving universal basic WASH by 2030. The global capital costs amount to $28.4 billion per year (range: $13.8 to $46.7 billion). However, despite this good news, the current allocations need to be redirected and there will need to be significantly greater spending on sanitation (accounting for 69% of the cost of basic universal WASH) and operations and maintenance, as well as in the most off-track countries which are mainly in sub-Saharan Africa and South Asia.
The World Bank at World Water Week 2015
As the global focus shifts to the Sustainable Development Goals (SDGs), and achieving universal access to water and sanitation, there will clearly be a need to mobilize private capital to help finance the necessary infrastructure. The Global Water Practice at the World Bank has been working with key public and private sector partners in over ten countries to mobilize domestic credit and address operating inefficiencies which negatively impact on the delivery of water and sanitation. To scale up (“billions to trillions”) it will be necessary to consider the incentives needed to attract and sustain such capital flows.