[6] Still, collecting precise scientific evidence regarding health outcomes that result from improved access to WASH is difficult due to a range of complicating factors.
The demand for groundwater is rapidly increasing with population growth, while climate change is imposing additional stress on water resources and raising the probability of severe drought occurrence.
[17] Reliance on groundwater is increasing in sub-Saharan Africa as development programs work towards improving water access and strengthening resilience to climate change.
The assumption that untreated groundwater is typically suitable for drinking due to its relative microbiological safety compared to surface water underpins this practice, largely disregarding chemistry risks.
[29]: 3 Fecal sludge is defined very broadly as what accumulates in onsite sanitation systems (e.g. pit latrines, septic tanks and container-based solutions) and specifically is not transported through a sewer.
[6] Health impacts resulting from a lack of safe sanitation systems fall into three categories:[36]: 2 The WHO has investigated which proportion of death and disease worldwide can be attributed to insufficient WASH services.
For example, open defecation – which is the most extreme form of "lack of sanitation" – is a major factor in causing various diseases, most notably diarrhea and intestinal worm infections.
[46] Diarrhea can be prevented - and the lives of 525,000 children annually be saved (estimate for 2017) - by improved sanitation, clean drinking water, and hand washing with soap.
Based on expert opinions and a literature survey, researchers at WHO arrived at the conclusion that approximately half of all cases of malnutrition (which often leads to stunting) in children under five is associated with repeated diarrhea or intestinal worm infections as a result of unsafe water, inadequate sanitation or insufficient hygiene.
[55] It refers to the NTD roadmap milestones that included, for example, eradication of dracunculiasis by 2015 and of yaws by 2020, elimination of trachoma and lymphatic filariasis as public health problems by 2020, intensified control of dengue, schistosomiasis and soil-transmitted helminthiases.
[65] Blind studies of WASH interventions also pose ethical challenges and difficulties associated with implementing new technologies or behavioral changes without the knowledge of the involved participants.
A randomized control trial in India concluded that the provision of chlorine tablets for improving water quality led to a 75% decreased incidence of cholera among the study population.
[83] Women are likely to be deterred from entering water utilities in developing countries because "social norms prescribe that it is an area of work that is not suitable for them or that they are incapable of performing well".
[87] WASH in schools, sometimes called SWASH or WinS, significantly reduces hygiene-related disease, increases student attendance and contributes to dignity and gender equality.
[88] Methods to improve the situation of WASH infrastructure at schools include, on a policy level: broadening the focus of the education sector, establishing a systematic quality assurance system, distributing and using funds wisely.
[87] The support provided by development agencies to the government at national, state and district levels is helpful to gradually create what is commonly referred to as an enabling environment for WASH in schools.
[91][92] Supervised daily group handwashing in schools is an effective strategy for building good hygiene habits, with the potential to lead to positive health and education outcomes for children.
[101]: 12 A report by ICRC states that "Measures depriving persons of their freedom must in no way, whatever the circumstances, be made more severe by treatment or material conditions of detention which undermine the dignity and the rights of the individual.
The budget allocated by the State for prisons is often insufficient to cover the detainees' needs in terms of food and medical care, let alone upkeep of water and sanitation facilities.
[101]: 12 Nevertheless, even with limited funds, it is possible to maintain or renovate decaying infrastructure with the right planning approaches and suitable low-cost water supply and sanitation options.
[103] The human rights to water and sanitation prohibit discrimination on the grounds of "race, color, sex, language, religion, political or other opinion, national or social origin, property, birth, disability or other status".
[110][26] This has been attributed to financial costs, inadequate technical training for operations and maintenance, poor use of new facilities and taught behaviors, and a lack of community participation and ownership.
[116]: 11 Data from 2023 from centralized sewage treatment plants in the United States indicate that methane emissions are about twice the estimates provided by IPCC in 2019, i.e. 10.9 ± 7.0 compared to 4.3-6.1 MMT (million metric tons) CO2-eq/yr.
[37]: 23 Climate change poses increased risks to WASH systems, particular in Sub-Saharan Africa where access to safely managed basic sanitation is low.
Adaptation measures for floods include for example: Review the siting of the water and wastewater treatment plants in floodplains, minimize the impact of floodwater on operational equipment.
[17] Four important activities to achieve climate resilient WASH services include: First, a risk analysis is performed to look at possible implications of extreme weather events as well as preventive actions.
speaks about reducing vulnerability and preventing negative developments: Some top-down interventions that work around power and politics may undermine indigenous knowledge and compromise community resilience.
[10] A scoping review of the literature found five key interrelated dimensions of empowerment in the WASH sector:[149] A qualitative study in Asutifi North District in Ghana conceptualized empowerment in terms of four major themes: availability of resources, WASH information, social and cultural structures, and agency (the ability to define and act on individual or shared goals, and to put them into effect).
[160][161] The JMP was already responsible for monitoring the UN's Millennium Development Goal (MDG) Target 7.C, which aimed to "halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation".
[3] Expanding WASH coverage and monitoring in non-household settings such as schools, healthcare facilities, and work places, is included in Sustainable Development Goal 6.