Building Inclusive Environments

2016 Global Innovation Challenge focused on Inclusive WaSH

The 800 million people with disabilities living in low- and middle-income countries experience inequities in access to education, employment, and social services. While unjust policies and social stigmas impede progress, the lack of safe and accessible water, sanitation, and hygiene facilities is crippling. To empower girls, children with disabilities, and other vulnerable populations toward self-efficacy, we collaborate with global organizations like UNICEF, building socially inclusive policies, tools, and environments.

What is Inclusive WaSH?

By Kory Smith

More than 15% of the world’s population has some form of disability, 80% of whom live in low- and middle-income countries where basic needs, such as sanitation, often go unmet. The Community for Global Health Equity's Inclusive WaSh team has recommended and begun to test core questions to monitor WaSH in schools through the Joint Monitoring Programme for Water and Sanitation, the official United Nations mechanism tasked with monitoring progress towards the Sustainable Development Goals in WaSH.

Through the 15-year campaign to achieve the United Nations’ Millennium Development Goals (2000-2015), 2.6 billion people gained access to improved drinking-water and 2.1 billion people gained access to improved sanitation. As a result, throughout much of the world, efforts and investments can now be steered toward healthcare, education, and other public health initiatives. While universal access to improved water sources appears in reach through the Sustainable Development Goals, the next 15-year campaign, meeting the target for improved sanitation will be a challenge, as 2.4 billion people still lack access to improved sanitation facilities. Moreover, universal coverage in both sectors – water and sanitation – will not be met if the needs of marginalized and vulnerable populations are not addressed. As of 2015, for example, approximately 360 million people with disabilities worldwide lacked access to improved sanitation facilities.

Water, sanitation, and hygiene (or WaSH) programs are critical for promoting public health and are linked to economic development. WaSH projects have been central to international development efforts, managing humanitarian crises such as refugee resettlement, and the general advancement of rural and urban areas throughout history. Improving WaSH efficacy is not only about improving the quality and scale of infrastructure; facilitating adoption of, education about, and management of systems is also necessary. In addition, WaSH interventions, especially in low-income settings, need to meet the physical and psychosocial needs and preferences of marginalized and vulnerable populations – such as children, older adults, girls and women, and people with disabilities. “Inclusive WaSH” is a human-rights approach to planning, design, and implementation that improves access for these groups.

Not only does the lack of sanitation access place both these individuals and their communities at risk for disease but it also has hidden consequences. In India, for instance, more than a third of school-age children with disabilities are not enrolled in schools, and, in Uganda, 94% of students with disabilities drop out prior to completion. One reason is the lack of accessible WaSH facilities in schools. Likewise, in both countries, due to perceived and real threats of verbal and physical assaults, girls entering puberty are equally vulnerable to not completing school, again, due in part to the planning, design, and oversight of sanitation facilities.

Unequal access to clean, safe, and functional water and sanitation is evident at all scales – disparities from country to country, city to city, household to household, and individual to individual. Meeting the needs of disenfranchised populations is a major priority if we are to achieve the UN goal of “water and sanitation for all.” The barriers that impede success in WaSH projects are numerous – lack of funds, know-how, materials, and/or land, as well as issues regarding cultural norms, maintenance, and other factors. Much of the emphasis has been on technological innovation, but this is not the primary problem; there are hundreds of excellent water and sanitation technologies available, even in low-income settings. Experience shows that water and sanitation projects need to be comprehensive, not technology-focused, and community led, not predetermined, to be effective. The need is for innovative business models, innovative policies and funding strategies, innovative, culturally-resonant educational programs, and innovative methods for coordinating across geographies and sectors.

Definitions

According to the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, improved sources of drinking-water include:

Piped water into dwelling
Piped water to yard/plot
Public tap or standpipe
Tubewell or borehole
Protected dug well
Protected spring
Rainwater

"Unimproved" sources of drinking-water include:

Unprotected spring
Unprotected dug well
Cart with small tank/drum
Tanker-truck
Surface water
Bottled water

According to the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, improved sanitation is:

Flush toilet
Piped sewer system
Septic tank
Flush/pour flush to pit latrine
Ventilated improved pit latrine
Pit latrine with slab
Composting toilet
Special case

"Unimproved" sanitation:

Flush/pour flush to elsewhere
Pit latrine without slab
Bucket
Hanging toilet or hanging latrine
Shared sanitation
No facilities or bush or field

Smith receives national book award for study of African city

Learn more

Patel, S., Lee, Y., Song, J. Y., & Sloditskie, G. (2020). Alternative Housing Delivery for Slum Upgrades: Perspectives from Architecture, Engineering, and Non-governmental Organizations. In K. Smith & P. Ram (Eds.), Transforming Global Health: Interdisciplinary Challenges, Perspectives, and Strategies. New York, NY: Springer.

Rembis, M., & Djaya., H. P. (2020). Gender, Disability, and Access to Health Care in Indonesia: Perspectives from Global Disability Studies. In K. Smith & P. Ram (Eds.), Transforming Global Health: Interdisciplinary Challenges, Perspectives, and Strategies. New York, NY: Springer.

Kang, J.-Y., & Aldstadt, J. (2019). Examining Time-dependent Effects of Water, Sanitation and Hygiene (WaSH) Interventions Using and Agent-based Model. Tropical Medicine and International Health.

Humphrey, J. H., Mbuya, M. N. N., Ntozini, R., Moulton, L. H., Stoltzfus, R. J., Tavengwa, N. V., Team, S. T. (2019). Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial. Lancet Global Health, 7(1), E132-E147.

View a full list of our publications

Our Working Solutions

Students partnering with the Appropriate Technology Centre in Uganda.

Students partnering with collaborator Asha Bamutaze at the Appropriate Technology Centre in Uganda

Identifying Needs Testing Options Scaling Up Evaluating Solutions

Contributing to the WHO Standards for WaSH in Schools
7/22/19
"The inclusion of water, sanitation and hygiene (WASH) in schools as part of the Sustainable Development Goals (SDGs), necessitates the development of national, regional and global estimates of WASH in schools (WinS) coverage to track progress over time...[Core questions and indicators for monitoring WASH in Schools in the Sustainable Development Goals] presents recommended core questions to support harmonized monitoring of WinS as part of the SDGs..agreed upon by the Global Task Team for Monitoring WASH in Schools in the SDGs, convened by the Joint Monitoring Programme for Water and Sanitation (JMP).
Acting Collectively for Equity (ACE)
8/6/18
This interdisciplinary studio assisted the Maradu municipality, in the state of Kerala in Southern India, by preparing a report informing the local government's city-wide sanitation planning process. A group of thirteen students from UB architecture, environmental engineering, public health and urban planning worked under the guidance of Drs. Samina Raja and Korydon Smith to gather, analyze, and synthesize relevant information. Students worked for three weeks collecting primary data on current drinking water sources, waste and wastewater management, and public health in collaboration and partnership with the Centre for Science and Environment. Their report, which includes a list of twenty-eight recommendations, was shared with the municipal government and key partners. Key findings included the need for improved and enlarged water and waste infrastructure to serve a growing population.
Developing a Sanitation for All Framework
1/19/18
More than 15% of the world’s population has some form of disability, 80% of whom live in low- and middle-income countries, where basic needs, such as sanitation, often go unmet. People with disabilities often face environmental, social, and institutional barriers to accessing sanitation facilities, presenting a major hurdle to achieving the UN’s Sustainable Development Goal of sanitation for all by 2030.