By Pankaj Thapa
According to the website of Water Aid Nepal, “one in ten people in Nepal lack access to clean water”. Figuratively, that would mean an estimated 3 million Nepalese do not have access to clean water – leading one to wonder how they are washing their hands during the health emergency, amidst other concerns?
The importance of washing your hands with soap and water, and practicing safe hygiene is barely spoken about as much as in the year 2020, thanks to COVID-19.
However, what is to happen to the narrative after the pandemic passes? Shall we continue to talk about hygiene as much? Or like the pandemic, that too shall pass?
It should not – it is a public health issue, and its inequitable access concerns us all.
What, therefore, is WASH?
In 2015, United Nations member states, in a collective action towards (a) ending poverty, (b) protecting the planet, and (c) ensuring all people enjoy peace and prosperity by 2030, arrived upon 17 Sustainable Development Goals (SDGs). Equitable and accessible water and sanitation for all is its sixth development goal; 6.2 explicitly mentions for women and girls.
WASH is an acronym for Water, Sanitation and Hygiene, and is a key public health issue with international development. Access to WASH includes safe water, adequate sanitation and hygiene education. Its importance can be listed as following:
WASH and public health:
In 2009, a cholera outbreak in Nepal’s mid and far-western districts claimed more than 300 lives – the outbreak was attributed to contamination of water.
In 2019, a diarrhoea outbreak in a village in Gulmi district hospitalised 84 households dependent upon the same source of water. As per Nepal Demographic and Health Survey 2016, diarrhoea is the most common illnesses among children and continues to be a major cause of childhood morbidity and mortality.
According to a UNICEF Report, in 2012, a total of 842,000 diarrhoea deaths (globally) were caused by inadequate WASH (502,000 from water, 280,000 from sanitation, and 297,000 from hand hygiene). According to the same report, improving access to adequate amounts of water from an adequately distanced source, hygienic sanitation facilities and promotion of hand washing are key interventions to reduce adverse effects on public health.
Therefore, equitable access to WASH is important for public health.
WASH and neglected tropical diseases:
According to WHO, neglected tropical diseases (NTDs) are a diverse group of communicable diseases that prevail in tropical and subtropical conditions (WHO). Several NTDs are related to WASH: trachoma, schistosomiasis, STH infections, neglected zoonoses, dengue haemorrhagic fever, dracunculiasis (guinea-worm disease) and lymphatic filariasis (elephantiasis).
Inadequate sanitation, lack of hygiene and lack of access to clean water plays a significant role in the transmission of NTDs. Therefore, equitable access to WASH is important to prevent NTDs, and to improve public health.
WASH and psychosocial health:
Let’s pause for a moment and race our minds to the several stone spouts we see around Kathmandu valley – whom do you predominantly see awaiting their turn with jars? Women and children.
According to Water Aid Nepal’s website, ‘although poor access to appropriate water, sanitation and hygiene (WASH) services is not the root cause of violence, it can increase individuals’ vulnerability to violence. For example,
In 2010, a report by Amnesty International said ‘men face being mugged, women face being raped, when going to the toilet after dark in Kenya’s slums’. In India, another report found out that ‘women were not eating so they won’t need to use a toilet until night time’. These are two out of a thousand stories – in Nepal, women going to fetch water from taps report being verbally abused and even harassed during such outings.
Furthermore, mothers fear for their children’s safety when going to collect water, absenteeism amongst school-going children is high when they are entrusted with the task of fetching water, and women are found to be under undue psychosocial stress due to lack of access to water, sanitation or hygiene.
Several studies have established a pattern of sexual, psychological, physical, and socio-cultural violence between lack of access to WASH, with several projects also showing improvements post-WASH intervention.
Therefore, equitable access to WASH is important for psychosocial health, and to improve public health.
WASH and Menstrual Hygiene Management (MHM):
MHM is defined as women and adolescent girls using a clean menstrual management material to absorb or collect menstrual blood, that can be changed in privacy as often as necessary for the duration of a menstrual period, using soap and water for washing the body as required, and having access to safe and convenient facilities to dispose of used menstrual management materials.
While socioeconomic status, personal preferences, local traditions and beliefs (for example Chhaupadi in Nepal), knowledge and awareness, and access to necessary resources play an important role in MHM, the effect of interest here is the reduction in adverse health and psychosocial outcomes associated with MHM as a result of improvements in WASH. As per WHO, it is biologically plausible that poor MHM influences the health of women and girls, while social ostracizing customs during menstruation have profound psychosocial effects on women and girls, and to an extent drives gender inequality.
Therefore, equitable access to WASH is important for Menstrual Health Management, and for public health.
WASH and socio-economic development:
Did you know that, inadequate access to safe water and inadequate access to sanitation and other infrastructure are two of the five defining characteristics of a slum? The others are poor structural quality of housing, overcrowding and insecure residential status.
As per a report by Sustainable Sanitation and Water Management, “improved access to water and sanitation has various impacts on social and economic development of millions of people”.
It helps in alleviation of poverty (less illness equals to greater productivity) and the time spent in collecting water can be allocated to other productive activities too. Those with access to water can grow home gardens, livestock, and increase nutrition within family members. Access to WASH curbs public health expenditure too.
Sanitation and safe water in health care facilities help ensure clean delivery and reduce neonatal deaths. Higher rates of child survival are a precursor to the demographic transition to lower fertility rates; having fewer children reduces women’s domestic responsibilities.
Having separate sanitation facilities for girls in schools increases their school attendance, especially after menarche. Improved water management (IWRM) in human settlements reduces transmission risks of such mosquito-borne illness as malaria and dengue fever.
Access to WASH also improves environmental sustainability – adequate treatment and disposal of excreta and wastewater contributes to better ecosystem management and less pressure on freshwater resources. Improved sanitation reduces flows of human excreta into waterways, helping to protect human and environmental health.
Therefore, you understand the importance of WASH, and its equitable access?