Category Archives: Research

Assessing equity: a way to improve sanitation service delivery in South African informal settlements

Assessing equity: a way to improve sanitation service delivery in South African informal settlements. Journal of Water, Sanitation and Hygiene for Development, September 2018.

This paper discusses the need to incorporate equity assessment into the planning and monitoring of sanitation service delivery to South African informal settlements. Equity assessment criteria were drawn from literature and a study of sanitation service delivery to informal settlements in three South African municipalities (Cape Town, Johannesburg and eThekwini) over the period 2012–2015. wash

Three key dimensions of equity – resource allocation, access and stakeholder perceptions – were identified. These had eight associated criteria: (1) funds allocated for basic sanitation, (2) number of staff allocated to informal settlements, (3) disparities in access, (4) proportion of functioning sanitation facilities, (5) menstrual hygiene management (MHM) inclusion, (6) access to information, (7) meets users’ notions of dignity, and (8) integration of the perspectives of key stakeholders.

Key findings of the study indicate that the current focus on reducing service backlogs largely ignores equity and there is a need to better address this through the incorporation of: equity assessments, improving access to information, and the inclusion of marginalised communities in the planning of sanitation services.

2018 WEDC conference papers on WASH financing, MHM, WASH in schools

WEDC conference papers are an important source for learning about WASH innovations and lessons learned in the field and more than 150 papers were accepted for the 2018 WEDC conference. Here is the link to all of the papers and selected papers are listed below, by topic:



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Mapping the evidence on WASH promotion in communities, schools and health facilities – 3ie Impact

Mapping the evidence on WASH promotion in communities, schools and health facilities. 3ie Impact, August 2018.  three


  • The number of rigorous studies on WASH promotion in households, schools and communities has increased substantially.
  • Very few rigorous studies exist on WASH promotion in medical facilities.
  • Many new studies evaluate previously under-researched approaches, such as community-led total sanitation, and measure important sector outcomes, including school attendance and reducing open defecation.
  • More studies are needed to measure programme effects on the sustained use of technologies and slippage back to open defecation.
  • A critical need exists for studies on promotional approaches for vulnerable populations, especially people living with disabilities, for whom no studies are available. New, high-quality systematic reviews are available, including ones on the effectiveness of hygiene and sanitation behavioural approaches and menstrual hygiene management.
  • Synthesis gaps remain for high-quality reviews on WASH interventions in schools and on decentralised delivery

Aug 22 webinars and recent WASH research


Aug 22, 2018: 6:00 pm EST – The Forgotten Juncture? Handwashing and Safe Management of Child Feces – This webinar, entitled The Forgotten Juncture? Handwashing and Safe Management of Child Feces will be co-hosted by the Global Handwashing Partnership, USAID, UNICEF, WEDC, and the International Water Centre

Aug 22, 2018: 9:00 am EST – Strengthening the Health System for Sustainable WASH Improvements: Adopting a Health Systems Approach at All Levels of WASH in HCF Programs – A new action-oriented learning program that brings together the WASH and health communities to focus on policy, evidence, and practice in WASH in HCFs. On monthly webinars, we will discuss experiences, challenges, successes, and lessons learned on topics within WASH in HCF.


The effect of SODIS water treatment intervention at the household level in reducing diarrheal incidence among children under 5 years of age: a cluster randomized controlled trial in Dabat district, northwest Ethiopia. BMC Trials, July 31. The SODIS intervention substantially reduced the incidence of diarrhea among under-five children in a rural community of northwest Ethiopia.

Are schoolchildren less infected if they have good knowledge about parasitic worms? A case study from rural Côte d’Ivoire. BMC Public Health, Aug 2. Specific knowledge about different types of helminths might not suffice to induce behavioural change which in turn reduces infection and reinfection with helminths.

Bacterial contamination of frequently touched objects in a tertiary care hospital of Pokhara, Nepal: how safe are our hands? Antimicrobial Resistance & Infection Control, Aug 6. High bacterial contamination of frequently touched objects with variety of potential pathogens and normal flora was detected. S. aureus was the most common bacterial isolate.


Child Height in India: Facts and Interpretations from the NFHS-4, 2015–16. Diane Coffey; Dean Spears, Aug 6. Factor (2)—the extent of open defecation—can be estimated using data from the NFHS-4. Coffey and Spears (2018) find that between the NFHS-3 and the NFHS-4, open defecation in India went down by 16.4 percentage points, from 55.3% to 38.9%. Combined with the Gertler et al (2015) effect estimate, this change in average exposure to open defecation would predict an increase in average height-for-age of 0.077 of a height-for-age standard deviation, due to improved sanitation.

Re-engineering the world’s trillion-dollar waste ecosystem. Medium, July 26. The Toilet Board Coalition wants to see recycling and reuse of biological waste become mainstream. It’s working with entrepreneurs and municipalities to find scalable ways to do it.

The impact of digitalisation on the water sector – An interview with Rebekah Eggers. IWA, Aug 7. We asked Rebekah Eggers, IBM’s WW IoT for Energy, Environment, & Utilities Business, and keynote speaker at the IWA World Water Congress & Exhibition 2018, what ‘going digital’ / ‘digitalisation’ really means for the sector, how to overcome key barriers to successfully digitise water, and ultimately, who can reap the benefits of this technological revolution.


Water, Sanitation, and Hygiene Characteristics among HIV-Positive Households Participating in the Global Enterics Multicenter Study in Rural Western Kenya, 2008–2012. AJTMH, Aug 6. This suggests that within this region of Kenya, HIV programs are effective in promoting the importance of practicing positive WASH-related behaviors among PLHIV.

9 WASH studies published so far in August 2018

Sachet water quality and product registration: a cross-sectional study in Accra, Ghana. Jnl Water Health, Aug 2018.
The results of this study suggest that while a substantial proportion of sachet water is sold without formal product registration, the microbial quality of the unlicensed water is consistently high in Accra, Ghana.

Access to drinking water: time matters. Jnl Water Health, Aug 2018.
This study aims to demonstrate the effect of adding a 30-minute collection time component to monitor access to drinking water. This study draws on household surveys from 17 countries to highlight the widespread burden of fetching water and its significant impact on estimates of coverage.

Acceptability and Feasibility of Sharing a Soapy Water System for Handwashing in a Low-Income Urban Community in Dhaka, Bangladesh: A Qualitative Study. AJTMH, Aug 2018.
Soapy water was an acceptable hand cleaning agent, with the bottle as a feasible dispenser. It was simple in design, cost-effective, replicable, popular with intervention recipient, and neighboring nonrecipients, and commonly shared among nonrelated households. The need to share expenses and product preparation served as a barrier.

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Recent research on sanitation,shared latrines, handwashing and other WASH issues

Below are links to an interesting report from the Rockefeller Foundation and other recently published journal articles and blogs:

Sanitation in the Context of Planetary Health: Opportunities and Challenges. Rockefeller Foundation, July 2018. Poor sanitation is a factor in an estimated 80% of all environment-related deaths. Poor sanitation costs countries between 0.5 and 7.2% of their annual GDP. The World Health Organization estimated total global economic losses to be US$260 billion annually in 2012. Investment in sanitation returns an estimated US$5-16 for every US$1 spen


Children Are Exposed to Fecal Contamination via Multiple Interconnected Pathways: A Network Model for Exposure Assessment. Risk Analysis, July 2018. This article describes a dynamic, multipathway exposure assessment model for children under five years of age in crowded, highly contaminated urban environments. Models of varying environmental concentrations of fecal microbes, child behaviors, and a comprehensive set of exposure factors were combined to simulate microbe transfer in a network structure from environmental sources to human ingestion.

Shared latrines in Maputo, Mozambique: exploring emotional well-being and psychosocial stress. BMC International Health and Human Rights, July 25.  Our data suggest that “improved”, shared facilities can reduce stress when proper maintenance and management systems are in place. Private, shared sanitation only had limited impact on users’ perceptions of safety, particularly at night, suggesting that safety concerns extend beyond the physical latrine structure. Our research demonstrates that factors including latrine location and neighborhood violence are important determinants of safety perceptions and corresponding psychosocial stress.

AJTMH Series on Typhoid

Introductory Article on Global Burden and Epidemiology of Typhoid Fever. AJTMH, July 25. This article is the introduction to a 12-paper supplement on global trends in typhoid fever. The Tackling Typhoid (T2) project was initiated in 2015 to synthesize the existing body of literature on typhoidal salmonellae and study national and regional typhoid fever trends.

Selected articles in the series



Social Influence on Handwashing with Soap: Results from a Cluster Randomized Controlled Trial in Bangladesh. AJTMH, July 30. Our study supports the conclusion that the presence of another individual after a toileting event can positively impact HWWS in a primary school setting.

Water, sanitation, and hygiene practices mediate the association between women’s empowerment and child length‐for‐age z‐scores in Nepal. Maternal & Child Nutrition, 26 July 2018. Empowered women had better WASH practices than nonempowered women, which translated into higher child LAZ. Child DD was not a mediating factor in the association between women’s empowerment and child LAZ. More research is needed to explore other pathways by which women’s empowerment may affect child nutrition outcomes.


Reaching for Resilience in East Africa. New Security Beat, July 2018. “Resilience isn’t an outcome, it is a process—and capacity-building is crucial,” said Chelsea Keyser, Deputy Chief of Party for USAID’s PREPARED program, during a recent event at the Wilson Center marking the end of the five-year project. PREPARED (Planning for Resilience in East Africa Through Policy, Adaptation, Research, and Economic Development) developed 14 different tools to help communities adapt to the impacts of the changing environment in the East African region, including unreliable rainfall and rising temperatures.

Clean water for the residents of one of Africa’s largest rubbish dumps. WSUP, July 24. The DFID funded programme operated under a payment by results framework, which meant that WSUP had to make good use of its strong relationship with NCWSC to ensure it could achieve the demanding targets.

Can Flexible Funding Lead to Better and Longer Lasting Results When it Comes to Water, Sanitation, and Hygiene Interventions? By Susan Davis, July 2018. Improve International convened a group of 14 people for the 3rd gathering of the Funder Collective for More Effective Partnerships. Over coffee, they met or got re-acquainted. Then representatives of three different types of funders – the Stone Family Foundation, Vitol Foundation, and Viva con Agua — talked about their take on a similar topic: Can flexible funding lead to better and longer lasting results when it comes to water, sanitation, and hygiene interventions?

Ingenious upcycling turns discarded medical device into water filter. Israel21c, July 29. Israeli startup repurposes discarded kidney dialysis filters to make pure water in Africa, Asia and Latin America.


Recent WASH research – July 26, 2018


The global risks of increasing reliance on bottled water. Nature Sustainability, July 16.
The rapid growth of bottled water use in low- and middle-income countries, and its normalization as a daily source of drinking water, does not provide a pathway to universal access. Generous and sustained investment in centralized and community utilities remains the most viable means for achieving safe water access for all.

Intrinsic and Instrumental Perspectives to Sanitation. SSM – Population Health, 18 July.
But what is often overlooked is the fact that a given public health intervention might be the end in itself. In other words, a given intervention might be worth investing in even if there are zero returns from investing in it. This intrinsic value, however, is often overlooked. In this commentary, we look specifically at sanitation, and why the development community should motivate sanitation interventions using an intrinsic value perspective.

Socio-environmental drivers of sustainable adoption of household water treatment in developing countries. NPJ, July 23.
The objective of this study is to analyze the interactions between such socio-environmental characteristics, rather than a single characteristic, in order to explain the adoption of HWT. Five socio-environmental characteristics and behavior determinants were analyzed using Qualitative Comparative Analysis (QCA) from 41 case studies in Africa, Asia, and South America. Results show that there is no single characteristic that alone explains the adoption of HWT.


Preferences and constraints – when does container-based sanitation address the binding constraint to uptake? WASHeconomics, July 23.
CBS is not a silver bullet for all urban sanitation challenges. However, it does have potential in some settings, especially informal settlements where space, ATP (cost-spreading) or tenancy/tenure are the binding constraint to uptake of improved sanitation.

Evaluation Shares Lessons Learned from DAI-Led Water Project in Indonesia. DAI, July 11.
A recent report that evaluated the sustainability of a DAI-led water resources and natural resource management program in Indonesia from 2004 to 2010 has shown that the majority of the partner water utilities continued to experience success after the donor-funded project ended.


Global Water Security e-Course, UNDER DEVELOPMENT. The UN Water Learning Centre (WLC). The Global Water Security course will provide a general and international approach to the ongoing issue of water security, with an overarching goal of educating professionals on the processes and conditions needed for safe, secure, sustainable and sufficient water for community development.


APPLYING OUTCOME MAPPING TO PLAN, MONITOR AND EVALUATE POLICY INFLUENCE; LEARNING FROM THE SHARE RESEARCH CONSORTIUM – SHARE has applied outcome mapping as an approach to plan, monitor and evaluate its research into use work. Outcome mapping (OM) is an iterative approach to project planning, monitoring and evaluation which seeks to identify, engage and work with the key stakeholders who are likely to help foster transformative change.

Behaviour Change for WASH: Policy Brief – This policy brief documents SHARE’s contribution to understanding behaviour change and associated health impacts. It provides recommendations for researchers and intervention implementers, policy makers and funders.