The growing global WASH crisis
Around the world, there is an alarming lack of access to essential water, sanitation and hygiene (WASH) services. Globally, 2.2 billion people lack safe drinking water, and 4.2 billion lack adequate sanitation. More than half of health care facilities in low- and middle-income countries do not have basic water supply, sanitation, and hygiene. This WASH crisis has severe consequences for global health, development, and the environment.
Contaminated water and inadequate sanitation are key drivers of waterborne diseases like cholera, dysentery, and typhoid. These preventable illnesses disproportionately impact the most vulnerable populations, especially children under five. Poor WASH access is also closely linked to malnutrition, stunting, and other long-term health impacts that impede child development and productivity. Beyond these direct health effects, lack of WASH services undermines education, economic opportunity, gender equality, and environmental sustainability.
The impacts of inadequate WASH ripple across sectors, making it a critical development priority. Increasing access to safe drinking water and proper sanitation can yield significant benefits, from decreasing disease burden to boosting productivity and resilience, particularly for women and children. However, progress in expanding WASH coverage has remained slow, with the world still far from achieving universal access.
The evolution of WASH as a global health priority
WASH emerged as a global health priority in the 1970s through initiatives like the UN Water Conference in 1977, which established the goal of providing access to safe drinking water and basic sanitation for all by 1990. While the global community made important strides, the Millennium Development Goal (MDG) target of halving the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015 was only partially achieved.
The post-2015 Sustainable Development Goals (SDGs) have raised the bar even higher, with SDG target 6.1 aiming for universal and equitable access to safe and affordable drinking water for all, and SDG target 6.2 seeking to achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, with special attention to the needs of women and girls and those in vulnerable situations.
This broader, more ambitious WASH agenda reflects the growing recognition that WASH is not just a basic service, but a fundamental human right that is essential for public health, environmental protection, and sustainable development. The UN General Assembly has explicitly recognized the human right to safe drinking water and sanitation, underscoring the importance of equitable access.
Advancing the WASH agenda: key priorities and strategies
To address the persistent WASH challenges and achieve the SDG targets, the global community has identified several priority areas and strategies:
1. Improving access to safely managed WASH services
The MDG monitoring framework focused on “improved” water and sanitation sources, but this did not guarantee that services were safely managed, reliable, or accessible. The SDG WASH targets now call for “safely managed” services – water sources that are located on premises, available when needed, and free of contamination, as well as sanitation facilities that safely contain excreta. This higher standard is crucial for protecting public health and the environment.
Attaining universal access to safely managed WASH will require significant investments in infrastructure, service delivery models, and supporting policies and regulations. Governments, development partners, and communities must work together to expand access, particularly in underserved rural and urban informal settlement areas.
2. Integrating WASH into health systems and services
Inadequate WASH in health care facilities undermines quality of care and increases the risk of healthcare-associated infections. USAID’s programs have demonstrated the importance of investing in WASH infrastructure, practices, and behavior change in health facilities to provide dignified, safe care and prevent maternal and child deaths.
Similarly, integrating WASH into nutrition, education, and other development programs can amplify health, social, and economic benefits. For example, ensuring access to WASH in schools can improve student health, attendance, and educational outcomes.
3. Addressing the menstrual health and hygiene (MHH) needs of women and girls
Approximately 500 million people worldwide face barriers to managing their menstruation safely, hygienically, and with dignity. Lack of access to menstrual products, private WASH facilities, and accurate information about menstruation can undermine the education, health, and participation of women and girls.
Addressing MHH requires a holistic, multi-sectoral approach that combines WASH infrastructure, menstrual product distribution, and menstrual health education. Engaging communities to address menstrual stigma and taboos is also crucial.
4. Promoting sustainable, climate-resilient WASH services
Climate change and environmental degradation threaten the sustainability and accessibility of WASH services. Salinization, water scarcity, and extreme weather events can disrupt water supply and sanitation infrastructure. WASH programs must incorporate climate adaptation and environmental protection strategies to ensure services withstand these growing challenges.
Sustainable WASH solutions, such as nature-based water treatment, groundwater recharge, and fecal sludge management, can safeguard resources and the environment. Integrating WASH into broader environmental and disaster risk reduction efforts is essential.
5. Driving behavior change and community engagement
Lasting WASH improvements depend on more than just infrastructure – they require changing social norms and behaviors around hygiene, sanitation, and water use. Effective WASH programs use participatory, community-driven approaches to increase ownership, acceptance, and sustained use of services.
Interventions like Community-Led Total Sanitation (CLTS) have mobilized entire communities to end open defecation, while handwashing campaigns have proven effective in shifting hygiene practices. These demand-side strategies must be coupled with supply-side efforts to ensure affordable, accessible, and reliable WASH services.
6. Strengthening WASH governance and financing
Achieving universal access to WASH requires robust policy, regulatory, and institutional frameworks, as well as sufficient, sustainable financing. Governments must develop national WASH strategies, build regulatory capacity, and allocate adequate budgets to deliver services, especially to the poorest and most marginalized populations.
Development partners can support governments in this endeavor through technical assistance, capacity building, and innovative financing mechanisms like results-based aid and microfinance. Engaging the private sector and civil society in WASH service delivery can also unlock additional resources and expertise.
Conclusion: WASH as a catalyst for health and development
As the global community strives to achieve the ambitious Sustainable Development Goals, water, sanitation and hygiene remain essential, cross-cutting priorities. Improving access to safe, reliable, and sustainable WASH services is not only a fundamental human right, but also a critical enabler of public health, environmental protection, gender equality, and socioeconomic development.
The evolution of WASH as a global health priority reflects a growing understanding of its multifaceted benefits. By integrating WASH into broader health, education, and environmental initiatives, we can leverage its catalytic potential to improve lives, strengthen communities, and build a more equitable, sustainable future for all. Continued innovation, investment, and multi-sectoral collaboration will be crucial to turn this vision into reality.
