The Dire Need for Improved WASH in Informal Settlements
Achieving universal access to safe water, sanitation, and hygiene (WASH) remains a critical global challenge, with dire consequences for the health and well-being of millions worldwide. According to the latest estimates, inadequate WASH is responsible for a staggering 1.4 million deaths each year, predominantly in low- and middle-income countries (LMICs). The vast majority of these preventable deaths are attributed to unsafe sanitation, which accounts for 564,000 lives lost annually, often from diarrheal diseases.
Diarrhea remains a major killer, but it is largely preventable through better WASH practices. In fact, improved water, sanitation, and hygiene could prevent 395,000 deaths among children under 5 each year. Open defecation, in particular, perpetuates a vicious cycle of disease and poverty, with the countries where it is most prevalent also experiencing the highest under-5 mortality rates, malnutrition levels, and wealth disparities.
Beyond reducing the risk of diarrhea, investments in sanitation yield substantial returns. A 2012 WHO study found that for every $1 spent on sanitation, there is a $5.50 return in the form of lower health costs, increased productivity, and fewer premature deaths. This underscores the tremendous value of improving WASH services, which is why the UN Deputy Secretary-General issued a call to action in 2013 to eliminate open defecation by 2025.
The Unique Challenges of WASH in Informal Settlements
While global progress is being made, the world is not on track to achieve universal coverage with basic sanitation services by 2030. Historical rates of progress would need to double, and for universal access to safely managed services, rates would need to increase fivefold. This challenge is particularly acute in urban areas, especially in dense, low-income, and informal settlements.
In these settings, the WASH landscape is fraught with complex obstacles. Sewerage is often precarious or non-existent, space for toilets is limited, and poorly designed pit latrines and septic tanks contaminate open drains and groundwater. Services for fecal sludge removal are frequently unavailable or unaffordable for residents. These inequities are compounded when polluted wastewater and storm runoff from wealthier areas drain into poorer, low-lying neighborhoods.
The effects of climate change, including floods, water scarcity, droughts, and sea-level rise, further exacerbate the WASH crisis in informal settlements. These climate impacts threaten to undermine existing services if they are not made more resilient. At the same time, the growing recognition of wastewater and sludge as valuable resources in a circular economy presents new opportunities, but only if they can be safely managed and used.
Prioritizing WASH in the Global Development Agenda
In response to these pressing challenges, the international community has taken important steps to elevate WASH on the global development agenda. In 2010, the UN General Assembly recognized access to safe and clean drinking water and sanitation as a human right, calling for international efforts to help countries provide these essential services.
Furthermore, the Sustainable Development Goals (SDGs) have set ambitious targets for water and sanitation. SDG 6.2 calls for “adequate and equitable sanitation and hygiene for all,” while SDG 6.3 aims to “halve the proportion of untreated wastewater and substantially increase recycling and safe reuse globally.”
As the leading global authority on public health, the World Health Organization (WHO) is at the forefront of efforts to prevent the transmission of WASH-related diseases. WHO monitors global burden of disease, tracks progress on WASH indicators, and provides evidence-based guidance to governments on effective service delivery and risk management practices.
WHO’s work includes promoting the use of tools such as sanitation safety planning, sanitary inspections, and guidelines on the safe use of wastewater and recreational water quality. The organization also supports cross-sectoral collaboration between WASH and health programs, recognizing the critical role of sanitation in preventing diseases like cholera, polio, and antimicrobial resistance.
Importantly, WHO’s guidance on WASH incorporates climate resilience, ensuring that strategies to improve access and safety can withstand the growing threats posed by a changing climate. By providing global data and evidence-based recommendations, WHO empowers countries and donors to make informed decisions about where to invest in WASH infrastructure and services.
Lessons from the Field: Exploring WASH Realities in Informal Settlements
To better understand the realities of WASH in informal urban settlements, a recent study conducted in-depth interviews and focus group discussions with residents of six informal communities in Kampala, Uganda. The findings from this research shed light on the complex and interconnected nature of WASH challenges facing these populations.
Despite the presence of various WASH infrastructure “upgrades” in the settlements, such as latrines, toilets, water taps, wells, and garbage collection systems, the researchers found that the WASH system and its components often failed to function as intended. Participants were acutely aware of the interdependence of different WASH elements, recognizing that the failure of one component, such as clean latrines or reliable trash collection, could undermine the entire system.
A key contributor to these system failures was the prevalence of point-of-use charges for accessing water taps and toilets. Many residents reported that these user fees made essential WASH services economically out of reach, forcing them to resort to alternative, often unsafe, practices like open defecation or using plastic bags. The precarious economic situation of informal settlement dwellers, exacerbated by the COVID-19 pandemic, further compounded these affordability challenges.
Participants also described the limitations of infrastructure upgrades in the absence of complementary interventions. For example, the construction of pit latrines without consideration for accessible roads made it difficult for trucks to empty the cesspits, leading to overflows and contamination. Similarly, the lack of space in crowded informal settlements hindered efforts to upgrade WASH systems in a way that avoided these systemic failure points.
Beyond infrastructure, the study highlighted the importance of behavioral and social factors in shaping WASH outcomes. While residents were often aware of hygiene practices like boiling water, the need to purchase fuel for boiling presented an additional financial barrier. Moreover, the maintenance and upkeep of communal WASH facilities, such as public toilets and wells, frequently failed due to a lack of community ownership or coordinated management.
Rethinking WASH Solutions for Informal Settlements
The findings from the Kampala study underscore the urgent need for a more holistic and context-specific approach to improving WASH in informal urban settlements. Piecemeal infrastructure upgrades alone are insufficient, as the interdependence of WASH system components requires a more integrated, systems-level perspective.
One critical area for intervention is the affordability and accessibility of WASH services. Eliminating or heavily subsidizing point-of-use charges for water and sanitation could significantly improve access for the most vulnerable populations. Exploring alternative sanitation technologies, such as waterless composting toilets, may also help overcome the limitations of conventional pit latrines in dense urban environments.
Effective management and maintenance of WASH infrastructure are equally important. Innovative community-based models, public-private partnerships, or municipal-level oversight may be needed to ensure the long-term functionality and sustainability of water points, public toilets, and sludge removal services.
Furthermore, behavioral change and community engagement strategies should be prioritized alongside infrastructure improvements. Enabling residents to take ownership of WASH facilities and fostering a sense of collective responsibility for their upkeep could enhance the success and longevity of WASH interventions.
Ultimately, addressing the WASH crisis in informal settlements will require a multifaceted approach that considers the unique social, economic, and environmental constraints of these communities. By adopting a systems-level perspective and prioritizing equitable, climate-resilient, and community-driven solutions, we can make significant strides towards achieving universal access to safe water, sanitation, and hygiene for all.
The Joint Action for Water blog is committed to sharing these critical insights and advocating for innovative WASH strategies that improve health, well-being, and environmental sustainability in informal urban settlements worldwide. Visit https://jointactionforwater.org/ to explore more resources and join the movement for universal access to WASH.
