Category Archives: Research

USAID WASH updates | Literature review on WASH systems

USAID Updates

Journal Articles

System Approaches to Water, Sanitation, and Hygiene: A Systematic Literature Review. Int. J. Environ. Res. Public Health 2020. Authors: by Nicholas Valcourt 1,2,*,Amy Javernick-Will 1,2,Jeffrey Walters 2,3 and Karl Linden 1,2 – 1-Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder 2-USAID Sustainable WASH Systems Learning Partnership, United State Agency for International Development | 3-College of Engineering, George Fox University, Newberg, OR 97132, USA

We conducted a wide-ranging systematic literature review of systems approaches for WASH across peer-reviewed, grey, and organizational literature. Our results show a myriad of methods, scopes, and applications within the sector, but an inadequate level of information in the literature to evaluate the utility and efficacy of systems approaches for improving WASH service sustainability. Based on this analysis, we propose four recommendations for improving the evidence base including: diversifying methods that explicitly evaluate interconnections between factors within WASH systems; expanding geopolitical applications; improving reporting on resources required to implement given approaches; and enhancing documentation of effects of systems approaches on WASH services.

Social Network Analysis for Water, Sanitation, and Hygiene (WASH): Application in Governance of Decentralized Wastewater Treatment in India Using a Novel Validation Methodology. Frontiers in Environmental Science, January 2020. Authors: Abishek Sankara Narayan1,2*, Manuel Fischer 1,3 and Christoph Lüthi 1 – 1 Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dubendorf, Switzerland, 2 Institute of Civil, Environmental and Geomatic Engineering, ETH, Swiss Federal Institute of Technology

The use of SNA as an appropriate diagnostic tool for planning Citywide Inclusive Sanitation is explored. Missing data is a major problem for SNA in the studies of governance situations, especially in low- and middle-income countries. Therefore, a novel validation methodology for incomplete SNA data, relying on information from internal and external experts is proposed. SNA and the validation method is then applied to study the governance of decentralized wastewater treatment in four cities of India. The results corroborate key differences between mega and secondary cities in terms of institutions, community engagement and overall sanitation situation including aspects of decentralized wastewater treatment plants, based on the city types.

Menstrual Hygiene Preparedness Among Schools in India: A Systematic Review and Meta-Analysis of System-and Policy-Level Actions. Int J Environ Res Public Health. 2020 Jan 19. Authors: Sharma S1,2, Mehra – 1 Researcher, Department of Clinical Sciences, Lund University, 2 MAMTA Health Institute for Mother and Child.

Less than half of the girls were aware of menstruation before menarche. Teachers were a less common source of information about menstruation to girls. Separate toilets for girls were present in around half of the schools.


Video – Transforming health systems: the vital role of water, sanitation and hygiene. WaterAid, January 2020. 

Dan Campbell

USAID WASH updates | WASH research on MHM, hygiene, financing, etc.

USAID Reports/Blog Posts

Tackling Southern Africa’s freshwater challenges by Dr Chris Brooks, USAID Resilient Waters Programme. IUCN, January 2020. Local communities in Southern Africa are facing severe water challenges regarding freshwater for drinking, sanitation, and other services. The Okavango and Limpopo river basins are key transboundary water bodies in this region, where USAID’s Resilient Waters Program operates.

USAID/CENTRAL ASIA ENVIRONMENT AND WATER FACTSHEET. USAID, Jan 2020. USAID’s introduction of integrated water resources management principles at the basin level provide a model for cooperation, governance and climate change adaptation that demonstrate the benefits of shared water management to the broader watershed.

PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) FACT SHEET. USAID, Jan 2020. The goal of PEER in Central Asia is to improve domestic and regional water management for better cross-border cooperation and less water waste.

Water for Life: Using CLA to Transform a WASH System into a Self-Reliant Apparatus. CLA, 2019. The CLA approach, still ongoing, has resulted in a self-reliant, functioning system that connects self-managed and self-financed community structures to local government institutes that are now implementing transparent and evidence-based resource allocation for WASH needs, and to trained, accountable government service providers and a stronger WASH private sector. – New blog posts, stories, news and events


The Global Risks Report 2020. WEF, Jan 2020. Water crises, in acknowledgement of their far-reaching consequences, are now categorized as a societal risk.

Untreated and Unsafe: Solving the Urban Sanitation Crisis in the Global South. World Resources Institute, Dec 2019. Cities must ensure universal access to safe, reliable, and affordable sanitation so that all urban residents can lead productive, healthy, and thriving lives. New analysis of 15 cities in the global South shows that on average, 62 percent of sewage and fecal sludge is unsafely managed somewhere along the sanitation service chain.

Journal Articles

Ruminant Fecal Contamination of Drinking Water Introduced Post-Collection in Rural Kenyan Households. IJERPH, Jan 2020. Authors: Latifah Hamzah, Alexandria B. Boehm, Jennifer Davis, Amy J. Pickering, Marlene Wolfe, Maryanne Mureithi and Angela Harris
Three combinations were identified:(i) ruminants in the compound, safe water extraction methods, and long storage time, (ii) ruminants, unsafe water extraction methods, and no soap at the household handwashing station, and (iii) long storage time and no soap.

Antimicrobial resistant enteric bacteria are widely distributed amongst people, animals and the environment in Tanzania. Nature Communicatons, Jan 2020. Multivariate models show no evidence that veterinary antibiotic use increased the odds of detecting AR bacteria, whereas there is a strong association with livelihood factors related to bacterial transmission, demonstrating that to be effective, interventions need to accommodate different cultural practices and resource limitations.

Can we ‘WaSH’ infectious diseases out of slums? International Journal of Infectious Diseases, Jan 2020. Authors: Allen G. Ross, Mahbubur Rahman, Munirul Alam, K. Zaman, & Firdausi Qadri –
In sum, a range of low cost WaSH solutions have been trialed but their impact has been modest when deployed with vaccination. Clinical trials of more expensive WaSH options are required in order to determine the best available technology at an affordable price. We can WaSH infectious diseases out of slums but at what cost?

What’s missing in MHM? Moving beyond hygiene in menstrual hygiene management. SRHM, Dec 2019. A focus on rights emphasizes both the naturalness of menstruation and the individual girl or woman as a rights-bearing agent. This reorientation can help to begin to shed the stigma around menstruation, and also to act as a catalyst to bring new voices into the global movement for better menstrual practices.

Poultry Ownership Associated with Increased Risk of Child Diarrhea: Cross-Sectional Evidence from Uganda. American Journal of Tropical Medicine and Hygiene, Jan 2020. Children in households with the above-median number (> 5) of poultry had 83% higher diarrhea prevalence than those with ≤ 5 poultry (adjusted PR = 1.83 [1.04, 3.23], P = 0.04). Children in households with the above-median number (> 2) of cows had 48% lower prevalence of respiratory infection than those with ≤ 2 cows (adjusted PR = 0.52 [0.35, 0.76], P < 0.005). There were no other significant associations between domestic animals and child health.


Closing gaps and financing taps: The next step for rural water supply. Water Blog, Jan 2020.  A new model in Tanzania is experimenting with a bold solution combining blended financing with emerging technologies. The pilot seeks to demonstrate that rural communities can repay 40% of the capital investment and maintenance service contracts without increasing the price of water.

Solving the big challenges of inclusive services through peer-to-peer learning. WSUP, Jan 2020. There is no greater way for city authorities and regulators to learn about developing inclusive water and sanitation services than from their peers – other institutions around the world who are confronting similar issues.

Research on water economics, CLTS and other WASH research updates

The latest issue of the Oxford Review of Economic Policy has several interesting articles:

Evidence-based policy analysis? The strange case of the randomized controlled trials of community-led total sanitation. Oxford Review of Economic Policy, Spring 2020. We show that cost–benefit analysis may still ‘save’ CLTS because small treatment effects may still yield net positive economic benefits if the costs of implementing CLTS programmes are modest. We also discuss the need to move beyond the desire for sanitation policies that are proven to be effective globally, and the importance of focusing on analysis of the local sanitation situation.


Shelmel Terefa, a school teacher, demonstrates face washing to students at his school in Aware-Golje village in the North Shewa Zone, Oromia, Ethiopia. Photo credit: Michael Amendolia/The Fred Hollows Foundation

Rethinking the economics of water: an assessment. Oxford Review of Economic Policy, Spring 2020. The conventional economic policy recommendations—privatization, pricing, and property rights—have struggled due to a failure to account adequately for the politics of water and the associated distributional conflicts.

We identify distinctive social and physical characteristics of water supply and demand, and explore their implications for three central areas of water policy: financing infrastructure, pricing, and property rights reform.

Rethinking the economics of rural water in Africa. Oxford Review of Economic Policy, Spring 2020. We explore why rural water is different for communities, schools, and healthcare facilities across characteristics of scale, institutions, demand, and finance. The findings conclude with policy recommendations to (i) network rural services at scale, (ii) unlock rural payments by creating value, and (iii) design and test performance-based funding models at national and regional scales.

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WASH research on privatization, child feces management, city sanitation planning and others

Also, be sure to check out the latest updates to

  • 2019: The Year in Review – Take a look at some of the highlights of the year to see how USAID is making an impact.
  • USAID’s Impact: Ex-Post Evaluation Series – The positive impacts of USAID’s water, sanitation, and hygiene (WASH) activities are often hard to dispute, especially during the immediate time period after projects comes to a close. But how sustainable are these outcomes several years later?
  • USAID in the News – recent articles from Feed the Future, Haiti and Malawi

USAID Kenya Article globalwaters

The impact of the private provision of WASH services on sustainable economic growth in sub-Saharan Africa. Advances in Social Sciences Research Journal, December 2019. By Michael W.Nicholson, USAID/Kenya – This paper analyzes the expanded role of the private sector in the provision of WASH services in Africa.  The  current  analysis  provides  an  empirical  inquiry  into  the  conditions  under which the private sector is attracted to the provision of WASH services and estimates its subsequent impact on both economic growth and inclusive development.

Upcoming Webinars

PRO-WASH – Prochain webinaire : Partage des expériences avec USAID/ACCES sur les stratégies de vente marketing et les mécanismes de financement pour l’assainissement rural – Quand? : Le mercredi 22 janvier à 9 h EST/UTC-5 en français.

Journal Articles

Child feces management (CFM) practices and fecal contamination: A cross-sectional study in rural Odisha, India. Science of The Total Environment, 20 March 2020. Authors: Valerie Bauza, Fiona Majorin, Parimita Routray, Gloria D.Sclar, Bethany A.Caruso, Thomas Clasen – Current CFM practices were found to increase fecal contamination in the environment and on hands. CFM hardware of potties and scoops can reduce fecal contamination, but had low use and shortcomings.

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Updates from WHO | Recent WASH research |ADB study on sanitation

We hope these informal WASH research updates have been useful to you in 2019. Please let us know if you have suggestions for future updates or if you wish to be removed from the subscriber list.

3-2-iDE-Cambodia WASH DIB-PR-07_Photo by Chhom Dinat

Also, be sure to check out for new blog posts, publications, events and news.


Water for Life: Using CLA to Transform a WASH System into a Self-Reliant Apparatus. CLA, 2019. The development challenge addressed in this case is increasing access to safe water for marginalized and under-served populations.

Transforming Communities and Staff One Latrine at a Time in Rural Angola. CLA, 2019. The WASH Project Team uses experiential exercises like the CLTS methodology to inspire community members to explore, discover and decide the best way to improve their water, sanitation and hygiene resources in Songo.


Water, sanitation, hygiene and health: a primer for health professionals. WHO, 2019. This WASH and health primer summarizes the status of WASH services globally and gives an overview of WASH interventions and linkages with health.

New global review of WASH and health – Safer Water Better Health. WHO, 2019. The comprehensive global review presented in Safer Water, Better Health updates the overall disease burden attributable to quantifiable effects of inadequate WASH for 12 major diseases, adverse health outcomes and injuries.

Position paper: Implications of recent WASH and nutrition studies for WASH policy and practice. WHO, 2019. In 2018, the WASH sector was surprised by three new high-quality studies that showed little or no impact of selected WASH interventions on reducing childhood diarrhoea and stunting. The WHO/UNICEF position paper summarizes the studies, contextualizes the findings within the wider body of evidence and distils the implications for future investments.


Product Design Supporting Improved Water, Sanitation, and Energy Services Delivery in Low-Income Settings. Sustainability, November 2019. Several approaches have been proposed in the literature supporting product design applied in low-income settings. These approaches have typically focused on individual- and household-level beneficiaries, with an emphasis on participatory, human-centered co-design methods. In this paper, we present a design approach that is, in contrast, focused on supporting providers of improved water, sanitation, and energy services.

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IDS sanitation research | PEER research proposals | Recent WASH research


Who is being left behind in Swachh Bharat Mission? How do we include them? Immersive research report by WaterAid India with Institute of Development Studies, gives insight into who is missed in sanitation programming in areas of India and how to include them. podcast

‘More or less: A rapid review of ‘water for toilets’ in rural India’, examines both technical and behavioural aspects surrounding water collection, management and consumption related to toilet use in rural India. It provides recommendations for steps forward.

Retrofitting of toilets is a complex and challenging stream of work and is included as one of the main components of Open Defecation Free-Sustainability (ODF-S) plans under Swachh Bharat Mission- Gramin (SBM-G). This rapid topic review ‘Retrofitting: The Next Step for the Swachh Bharat Mission?’ aims to provide recent evidence and insights into the scale and nature of the challenges of retrofitting.


PEER Cycle 9 Call for Proposals Now Open – On behalf of PEER’s sponsors at USAID, the National Academies are happy to announce that this year’s cycle of PEER is now open and accepting proposals. There are several country-specific focus areas: urban WASH and transboundary water in Afghanistanclean energy in Bangladeshmultiple research sectors in Tunisia, and bioremediation of dioxins and furans in Vietnam.


School-based, blacklight handwashing program can improve handwashing quality and knowledge among pre-school aged children. Evaluation and Program Planning, February 2020. Authors: Deirdre Dingman, Jingwei Wub, Heather M.Murphy – Puzzles and structured handwashing observations can be used as handwashing evaluation tools. Use of a black light technology as an educational tool can help to improve handwashing quality among pre-school aged children.

Impact of the “BALatrine” Intervention on Soil-Transmitted Helminth Infections in Central Java, Indonesia: A Pilot Study. Trop. Med. Infect. Dis., Dec 2019. We tested a low-cost, locally designed and constructed all-weather latrine (the “BALatrine”), together with community education promoting appropriate hygiene-related behaviour, to determine whether this integrated intervention effectively controlled soil-transmitted helminth (STH) infections.

Relationship of sanitation, water boiling, and mosquito nets to health biomarkers in a rural subsistence population. Am Jnl Human Biology, Dec 2019. This suggests that relatively low cost and low maintenance public health interventions may wish to focus on latrine use, as there is unmet need and potential health benefits for those who use latrines. Additionally, while the cost is higher, public health organizations aimed at improving sanitation may be able to use minimally invasive field‐collected biomarkers as a diagnostic to objectively test the efficacy of interventions with greater specificity than anthropometric measurements.

Citywide Inclusive Sanitation through Scheduled Desludging Services: Emerging Experience from India. Front. Environ. Sci., 27 November 2019. This paper first reviews the need for regular desludging of septic tanks. It then outlines the emerging experience of design and implementation of scheduled desludging for inclusive, equitable, and sustainable sanitation to achieve social and environmental benefits in two Indian cities. In these cities, a performance-linked annuity payment framework is used to engage a private desludging enterprise. Payment is met through a sanitation tax and transfer from the general property taxes.


Kenya RAPID video shows impact in year 4. MWA, Dec 2019. See this above video for an update on Kenya RAPID as it nears its fifth and final year of implementation.


Water, Sanitation Can Systematically Prevent Antimicrobial Resistance in India. The Wire, Dec 2019. Limited access to water, sanitation and waste management services, increases risk of infections and leads to greater dependence on antibiotics which contributes to AMR.

By, for, and of the People: How Citizen Science Enhances Water Security. New Security Beat, Dec 2019. This article is part of ECSP’s Water Security for a Resilient World series, a partnership with USAID’s Sustainable Water Partnership and Winrock International to share stories about global water security.

WASH research on CLTS, latrines, menstrual hygiene, food hygiene, etc.

In addition to the studies and reports listed below, recent updates to include:


How does Community-Led Total Sanitation (CLTS) promote latrine construction, and can it be improved? A cluster-randomized controlled trial in Ghana. Social Science & Medicine, 2 December 2019. Authors: Miriam Harter, Jennifer Inauen, Hans-JoachimMosler – CLTS increased latrine coverage by 67.6%. CLTS achieved changes in psychosocial determinants based on a psychosocial model.

Costs and Willingness to Pay for Pit Latrine Emptying Services in Kigali, Rwanda. Int. J. Environ. Res. Public Health, November 2019. Authors: Zachary Burt, Rachel Sklar and Ashley Murray – Our results show that households had strong preferences for fecal sludge (FS) treatment, formalized services (which include worker protections), and distant disposal.

Infant Food Hygiene and Childcare Practices in Context: Findings from an Urban Informal Settlement in Kenya. The American Society of Tropical Medicine and Hygiene, November 18, 2019. Authors: Jane Awiti, Odhiambo Mumma, Oliver Cumming, Sheillah Simiyu, Alexandra Czerniewska, Rose Evalyne Aseyo, Damaris Nelima Muganda, Emily Davis, Kelly K. Baker and Robert Dreibelbis – Our findings demonstrate that behaviors associated with food contamination, such as hand feeding and storing food for extended periods, are determined largely by the larger social and economic realities of primary caretakers. Data also show how caregiving within an informal settlement is highly dynamic and involves multiple individuals and locations throughout the day.

Economic cost analysis of low-cost sanitation technology options in informal settlement areas (case study: Soweto, Johannesburg). International Journal of Hygiene and Environmental Health, January 2020. Authors: Musa Manga, Jamie Bartram, Barbara E.Evans – The study revealed that simplified sewerage is the cheapest option for Soweto informal settlement, even when the costs of pumping and treatment are included.

Gendered Water Insecurity: A Structural Equation Approach for Female Headed Households in South Africa. Water, November 2019. Authors: Saul Ngarava, Leocadia Zhou, Nomakhaya Monde – The study concludes that there are dynamic relationships in water insecurity (exposure, sensitivity and adaptive capacity) for female-headed households in South Africa.

Resilience by design: A deep uncertainty approach for water systems in a changing world. Water Security, April 2020. Resilience by Design is a generalizable approach offering important new methods of planning and managing for the resilience of critical infrastructure.


Health, Safety and Dignity of Sanitation Workers: An Initial Assessment. World Bank, November 2019.

Measurement in the study of menstrual health and hygiene: A systematic review and audit, November 2019. Authors: Julie Hennegan, Deborah Jordan, Brooks Kellogg, J. Schwab G.J. Melendez-Torres. Results of this audit indicate the need for the development and validation of new measures, and the evaluation of the performance of existing measures across contexts. In particular, the definition and measurement of menstrual practices, knowledge, attitudes, norms and restrictions should be addressed.


Channeling Financial Flows for Urban Water and Sanitation. CSIS Briefs. November 27, 2019. Through development agencies like USAID and OPIC, the United States can leverage additional private capital and increase the efficiency of existing water and sanitation programs.

Glass Half Full? Innovative Technologies Could Increase Global Water Security. New Security Beat, November 21, 2019. This article is part of ECSP’s Water Security for a Resilient World series, a partnership with USAID’s Sustainable Water Partnership and Winrock International to share stories about global water security.

New SHARE research on handwashing, food hygiene, position paper on the WASH Benefits and SHINE studies updates | New WHO, WSUP reports | WASH research updates

Recent updates to

Bruce Gordon and Oliver Subasinghe on the 2019 Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) Report – The latest podcast from Global Waters Radio features a conversation with Bruce Gordon, Coordinator for Water, Sanitation, Hygiene and Health at the World Health Organization (WHO), and Oliver Subasinghe, Communications and Data Advisor with the USAID Water Office.

Children wash their hands outside school in Samabogo, Mali.

Children wash their hands outside school in Samabogo, Mali.

DESIGNING VIABLE SANITATION ENTERPRISES – A MARKET BASED SANITATION GAME – USAID/WASHPaLS developed a game called Designing Viable Sanitation Enterprises to serve as a tool for MBS practitioners to understand and appreciate the interactions between the elements of a sanitation enterprise, the entrepreneur, and the broader context.

USAID Seeks Input on its Water and Development Research Agenda – To take advantage of the concentrated water, sanitation, and hygiene (WASH)–sector knowledge represented at the 2019 University of North Carolina Water and Health Conference, we held a consultation designed to share our process in developing a research agenda.

USAID in the News – Cambodia – Stone Family Foundation, IDE and USAID Launch Sanitation Development Impact Bond.


Watering the NDCs: National Climate Planning for 2020 and Beyond. AGWA, 2019. Watering the NDCs provides guiding principles and recommendations for national climate planners and decision-makers to help ensure they meet their goals set out in National Adaptation Plans and Nationally Determined Contributions.

Safer water, better health. WHO, 2019. This high disease burden could be largely prevented with existing interventions and prevention strategies, which are described in this report.

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Implications of recent WASH and nutrition studies for WASH policy and practice – WHO/UNICEF position paper

Implications of recent WASH and nutrition studies for WASH policy and practice – WHO/UNICEF position paper, November 2019. Children wash their hands outside school in Samabogo, Mali.

The WHO/UNICEF position paper summarizes the studies, contextualizes the findings within the wider body of evidence and distills the implications for future investments. The paper is accompanied by a recorded interview with the heads of WASH for WHO and UNICEF and the lead author of a consensus statement from leading researchers.

An excerpt – What are the implications for WASH programming?

The findings of WASH Benefits and SHINE are not a reason to do less on WASH. Conversely, the historical significance of WASH in disease control, the strong conceptual basis for WASH (Box 2) and the need for WASH to reduce the potential for outbreaks in addition to breaking endemic transmission all indicate that the WASH sector collectively needs to do more and better to reach the ambitious targets of the SDGs.

The findings also highlight blind spots in typical WASH programming – particularly the role of animal waste and fecal contamination of food during irrigation and food preparation that are often overlooked in WASH programme design.

Many have called for transformative WASH In response to the studies but with some ambiguity around what is meant. While the consensus is that this implies interventions that lead to a comprehensively clean environment (Box 1), the path to this result is not universally agreed.