Leaving no one behind: Evaluating access to water, sanitation and hygiene for vulnerable and marginalized groups

Ethnicity and access to water, sanitation, and hygiene in Bangladesh: a study using MICS data and policy reviews

INTRODUCTION

Safe drinking water, sanitation, and hygiene (WASH) are crucial to human health. Reducing inequalities and ensuring universal access to WASH are essential to achieving the agenda of sustainable development. We aimed to measure access to WASH among ethnic minority populations in Bangladesh and understand the situation and factors affecting WASH practices among them. Additionally, we reviewed policy related to WASH to highlight the inequality faced by ethnic minority populations.

METHODOLOGY

We utilized data from the multiple indicator cluster survey-2019. We used the chi-square test for bivariate analysis and multilevel mixed-effect logistic regression analyses to identify the effect of ethnicity on WASH in Bangladesh after controlling selected covariates. Furthermore, we systematically reviewed Bangladesh's WASH-related policies and programs.

FINDINGS

While 98.5% of Bengalis had access to basic drinking water services, the percentage is 60.6% for the ethnic minority population. For improved sanitation facilities not shared with others, the difference between Bengali and ethnic populations was 22.3% (64.6% vs. 42.3%). On the other hand, 75% of the Bengali population had a handwashing facility with water and soap, and 50% of the ethnic population had them. Ethnicity appeared to be a statistically significant predictor of every component of WASH. Compared to Bengali, the ethnic population had 87%, 45%, 31%, and 45% less access to water (aOR = 0.13, p ≤ 0.001), sanitation (aOR = 0.55, p ≤ 0.001), and handwashing (aOR = 0.69, p ≤ 0.05), and WASH facilities aOR = 0.55, p ≤ 0.001), respectively. Among the policies of Bangladesh, only one identified action for WASH rights of ethnic minorities.

CONCLUSION

The government should identify the issues of WASH among ethnic minorities and represent them adequately in policies to achieve the aim of 'leaving none behind' of sustainable development goals.

Development of integrated assessment tool for water, sanitation and hygiene (WASH) services in non-household settings under climate change context

Access to improved water, sanitation, and hygiene (WASH) services is crucial in recognizing human rights to water and sanitation and due to their impacts on education, livelihoods, and human health. However, these services are often inadequate in non-household settings such as prisons, refugee camps, schools, and healthcare facilities. Progress in monitoring to ensure sustainable services in these settings has been limited. Although several tools are available to assess WASH services in both household and non-household settings, they have limitations, and none has taken a holistic approach to evaluate WASH performance in all non-household settings. Furthermore, the impacts of climate change on WASH services are rarely considered in these evaluations, making the inadequacies of WASH services worse. To address these gaps, an integrated tool was developed to assess WASH performance in non-household settings, incorporating financial, institutional, environmental impact, technical, social, and climate change factors. The tool provides scores for indicators to solve the problem of a lack of final aggregated data to enable decision-makers to determine the level of WASH performance in a setting. Moreover, it provides qualitative explanations for each score, allowing decision-makers to identify areas for improvement. This tool offers valuable and insightful data for improving WASH facilities and ensuring sustainable services in non-household settings, particularly for WASH service providers and local governments.

Coverage of safely managed water, sanitation and hygiene: An application of small area estimation

Disaggregated information on welfare indicators is useful for targeted policies. This study constructs geographic maps of water, sanitation, and hygiene (WASH) for provinces and districts in Vietnam (which has 63 provinces and 712 districts). The study finds that poorer provinces and districts tend to have remarkably lower access to safely managed sanitation and water. Provinces in the Northern Midlands and Mountain Areas, and Central Highlands have the lowest level of access to safely managed sanitation and drinking water. There is a great variation in the availability of WASH facilities between districts within the same provinces. Additionally, the study highlights that districts with a higher population of ethnic minorities tend to experience lower rates of access to safely managed sanitation and drinking water. Even within the same district, moreover, ethnic minorities face greater challenges in accessing safely managed sanitation and drinking water compared to the majority Kinh population.

Modeling water inequality and water security: The role of water governance

Water Inequality, Water Security and Water Governance are fundamental parameters that affect the sustainable use of water resources. Through policy formulation and decision-making, Water Governance determines both Water Security and Water Inequality. Largely, where Water Inequality exists, Water Security is undermined through unsustainable water use practices that lead to pollution of water resources, conflicts, hoarding of water, and poor sanitation. Incidentally, the interconnectedness of Water Governance, Water Inequality and Water Security has not been investigated previously. This study modified the Gini coefficient and used a Logistics Growth of Water Resources Model (LGWR Model) to access Water Inequality and Water Security mathematically, and discussed the connected role of Water Governance. We tested the validity of both models by calculating the actual Water Inequality and Water Security of Ghana. We also discussed the implications of Water Inequality on Water Security and the overarching role of Water Governance. The results show that regional Water Inequality is widespread in some parts. The Volta region showed the highest Water Inequality (Gini index of 0.58), while the Central region showed the lowest (Gini index of 0.15). Water Security is moderately sustainable. The use of water resources is currently stress-free. It was estimated to maintain such status until 2132 ± 18 when Ghana will consume half of the current total water resources of 53.2 billion cubic meters. Effectively, Water Inequality is a threat to Water Security, results in poverty, under-development heightens tensions in water use, and causes instability. With proper Water Governance, Water Inequality can be eliminated through formulating and implementing approaches that engender equal allocation and sustainable use of water resources.

Reviewing wood-based solar-driven interfacial evaporators for desalination

Solar‒driven interfacial water evaporation is a convenient and efficient strategy for harvesting solar energy and desalinating seawater. However, the design and fabrication of solar evaporators still challenge reliable evaporation and practical applications. Wood-based solar-driven interfacial water evaporation emerge as a promising and environmentally friendly approach for water desalinating as it provides renewable and porous structures. In recent years, surface modifications and innovative structural designs to prepare high performance wood-based evaporators is widely explored. In this review, we firstly describe the superiority of wood for the fabrication of wood-based solar evaporators, including the pore structure, chemical structure and thermal insulation. Secondly, we summarize the recent developments in wood-based evaporators from surface carbonization, decoration with photothermal materials, bulk modification and structural design, and discuss from the aspects of water transportation capacity, thermal conductivity and photothermal efficiency. Finally, based on these previous results and analysis, we highlight the remaining challenges and potential future directions, including the selection of high-efficient photothermal materials, heat and mass transfer mechanism in wood-based evaporators including large-scale production at a low cost.

Attainment of water and sanitation goals: a review and agenda for research

One-fourth of the global population is without basic drinking water and half of the global population lacks sanitation facilities. The attainment of water and sanitation targets is difficult due to administrative, operational, political, transborder, technical, and policy challenges. Conducted after 5 years from the adoption of sustainable development goals by the United Nations reviews the initiatives for improving access, quality, and affordability of water and sanitation. The bibliometric and thematic analyses are conducted to consolidate the outcomes of scientific papers on sustainable development goal 6 (SDG 6). Africa is struggling in relation with water and sanitation goals, having 17 countries with less than 40% basic drinking water facilities and 16 countries with less than 40% basic sanitation facilities. Globally, the attainment of water and sanitation goals will be depended on economic development, the development of revolutionary measures for wastewater treatment, and creating awareness related to water usage, water recycling, water harvesting, hygiene, and sanitation. Behavioral changes are also required for a new water culture and the attainment of water and sanitation goals by 2030.

Sustainability in Peri-Urban Informal Settlements: A Review

The study of peri-urbanization attracted attention in the final quarter of the 20th century, due to the pace it acquired worldwide and the implication that urbanization and overall settlement patterns have on social sustainability and development. Theoretical and conceptual achievements are remarkable. Multi-country collaboration has produced a growing body of research on sustainability and peri-urban settlements. There is a lack, however, of a review of the practices of peri-urban informal settlements, the predominant mode of urban expansion, mainly in developing and rapidly urbanizing regions of the world. The purpose is, then, to systematize, from recent literature, the knowledge of the context, challenges, and practices, as well as their impacts and potential courses of action, to ensure sustainability in human–natural complex of the territory beyond urban cores, suburbs, or slums. A systematic review approach was adopted, for articles published in reputable journals, with support of previous reviews, books, and reports. A pragmatist combination of content analysis and critical review identified core topics and highlighted contrasting views. An analytical framework is proposed. Four categories—drivers, challenges and practices, impact, and future trends—are proposed as an adequate approach to systematizing the literature. The review finds that the practices focus on service and resource provision, on regulations to approximate informal to formal institutions, and on an economy founded on the resource base and service provision. This review provides insights on future trends and research topics.

Communicating Water, Sanitation, and Hygiene under Sustainable Development Goals 3, 4, and 6 as the Panacea for Epidemics and Pandemics Referencing the Succession of COVID-19 Surges

WASH (water, sanitation, and hygiene) has become the most crucial amenity in the past decade for every individual on the planet. In the UN agenda for 2030, which created 17 Sustainable Development Goals (SDGs), SDGs 3, 4, and 6 directly correlate with WASH practices and management for creating a good health hygiene environment for all. The dearth of WASH facilities has created barriers for averting the transmission of COVID-19, motivating the concept of WASH as the primary step of precaution and prevention, which includes WASH practices, communication for literacy, and positive behavioral changes primarily in developing and low-income countries. This Review deals with the complex concept of correlation of WASH and SDGs 3, 4, and 6 while defining elaborate WASH practices, including the prominence of clean water, the need for sanitation facilities, and health hygiene for good health and immunity for preparedness for and during epidemics and pandemics. Certain risk factors explain the sectors in which the gaps exist, creating a gap for implementation of WASH practices in epidemics and pandemics across the globe. Further, COVID-19 surge succession is presented along with data of different variants that have occurred. The need of WASH understanding is required using different tools (audio-visual, social media, print media, and mass media) and strategies (communication, advocacy, and positive behavioral changes) for every individual as an act to counter consequences during and after the COVID-19 pandemic and as a routine practice for future preparedness. This Review gives a detailed concept of WASH understanding for every sector from community to government agencies and research professionals to act immediately for the sustainable future of humanity.

Social and geographic inequalities in water, sanitation and hygiene access in 21 refugee camps and settlements in Bangladesh, Kenya, Uganda, South Sudan, and Zimbabwe

INTRODUCTION

Many refugees face challenges accessing water, sanitation, and hygiene (WASH) services. However, there is limited literature on WASH access for refugee populations, including for menstrual health services. Unmet WASH access needs may therefore be hidden, amplifying morbidity and mortality risks for already vulnerable refugee populations. The aim of this study was therefore to quantitatively analyze WASH access among refugee camps, with a focus on households with women of reproductive age.

METHODS

This was a cross-sectional study that utilized the Standardized WASH Knowledge, Attitude and Practice (KAP) Survey. A total of 5632 household questionnaires were completed by the United Nations Refugee Agency in 2019 in 21 refugee camps and settlements in Bangladesh, Kenya, South Sudan, Uganda, and Zimbabwe. WASH access (14 items) and social and geographic stratifiers were analyzed at the household-level including the refugee camp, country of the settlement, having women of reproductive age, members with disability/elderly status, and household size. We calculated frequencies, odds ratios, and performed bivariate and multivariate analyses to measure inequalities. We developed a Female WASH Access Index to characterize WASH access for households with women of reproductive age.

RESULTS

Most refugee households had high levels of access to improved water (95%), low levels of access to waste disposal facility (64%) and sanitation privacy (63%), and very low access to basic sanitation (30%) and hand hygiene facility (24%). 76% of households with women of reproductive age had access to menstrual health materials. WASH access indicators and the Female WASH Access Index showed large inequalities across social and geographic stratifiers. Households with disabled or elderly members, and fewer members had poorer WASH access. Households with women of reproductive age had lower access to basic sanitation.

CONCLUSIONS

Large inequalities in WASH access indicators were identified between refugee sites and across countries, in all metrics. We found high levels of access to improved water across most of the refugee camps and settlements studied. Access to basic hygiene and sanitation, sanitation privacy, waste disposal, and menstrual health materials, could be improved across refugee sites. Households with women of reproductive age, with 4+ members, and without members with disability/elderly status were associated with higher WASH access. The female WASH access index piloted here could be a useful tool to quickly summarize WASH access in households with women of reproductive age.

Going beyond Global Indicators—Policy Relevant Indicators for SDG 6 Targets in the Context of Austria

Bringing forward sustainable transformation as envisioned within the Agenda 2030 requires comprehensive monitoring of the 17 Sustainable Development Goals (SDGs) formulated therein. To monitor and report progress on goal 6 on clean water and sanitation and its eight pertinent targets, 11 indicators were stipulated in an elaborated process. Yet, through continuous scientific and public scrutiny and debate several gaps and weaknesses were identified. Amongst others, these globally defined indicators are found to reflect weakly the diversity of national realities, capacities and levels of development. To translate the targets into national contexts and fully cover all aspects of the SDG 6 targets, the utilization of complementary indicators is recommended. Within this paper, following a critical appraisal of the SDG 6 indicators, possible complementary indicators are collected from literature and screened based on their quality, relevance for the national context and data availability. A deepened status quo of the SDG 6 targets and corresponding problem areas are outlined for the context of Austria, where water and sanitation infrastructure as well as regulation and governance of water bodies are widely established. Despite increasing the monitoring effort, it is concluded that complementary indicators are practicable to support coherent policy-making and ultimately contribute to the Agenda 2030’s aspiration that all countries take action.

Where Do We Stand Now? A Bibliometric Analysis of Water Research in Support of the Sustainable Development Goal 6

The connections between the scientific findings and SDG 6 are often not clear, which results in increasing the gap between technical developments and academic discourse, and the policy practitioners and/or implementers. The present paper explores the existing scientific research on water that directly connects to SDG 6 using a bibliometric analysis. The 637 scientific articles published between 2015–2021 (till 13 May 2021) were investigated for temporal development, scientific collaboration, existing research focus and the gaps. Interdisciplinary journals such as Science of the Total Environment and Journal of Environmental Management are found to be dominant sources along with water specific journals such as Water Research and Water (Switzerland). Open access journals make a dominant footprint and majority of author collaborations are found among authors from countries such as USA and UK while the research connections among authors from Global South are observed to be weak. Targets 6.1 (safe and affordable water), 6.3 (treatment and reuse of wastewater) and 6.5 (IWRM including through transboundary cooperation) are identified to be the highest referred to targets in scientific research in support of SDG 6. Though a significant evolution of scientific research is observed in connection to SDG 6 with increasing studies on groundwater, water governance, wastewater treatment, etc., in recent years, scientific studies connecting emerging concepts such as water security, water-energy-food nexus and ecosystem based approaches are still in an infant stage which calls for more research connecting these concepts and approaches to SDG 6 targets to attain a sustainable water environment by 2030 and beyond. This paper significantly contributes to tracking the progress in scientific research in connection to SDG 6 as well as highlights the hotspots where more collaboration between scientific communities and policy makers are required.

A planetary health model for reducing exposure to faecal contamination in urban informal settlements: Baseline findings from Makassar, Indonesia

BACKGROUND

The intense interactions between people, animals and environmental systems in urban informal settlements compromise human and environmental health. Inadequate water and sanitation services, compounded by exposure to flooding and climate change risks, expose inhabitants to environmental contamination causing poor health and wellbeing and degrading ecosystems. However, the exact nature and full scope of risks and exposure pathways between human health and the environment in informal settlements are uncertain. Existing models are limited to microbiological linkages related to faecal-oral exposures at the individual level, and do not account for a broader range of human-environmental variables and interactions that affect population health and wellbeing.

METHODS

We undertook a 12-month health and environmental assessment in 12 flood-prone informal settlements in Makassar, Indonesia. We obtained caregiver-reported health data, anthropometric measurements, stool and blood samples from children < 5 years, and health and wellbeing data for children 5-14 years and adult respondents. We collected environmental data including temperature, mosquito and rat species abundance, and water and sediment samples. Demographic, built environment and household asset data were also collected. We combined our data with existing literature to generate a novel planetary health model of health and environment in informal settlements.

RESULTS

Across the 12 settlements, 593 households and 2764 participants were enrolled. Two-thirds (64·1%) of all houses (26·3-82·7% per settlement) had formal land tenure documentation. Cough, fever and diarrhoea in the week prior to the survey were reported among an average of 34.3%, 26.9% and 9.7% of children aged < 5 years, respectively; although proportions varied over time, prevalence among these youngest children was consistently higher than among children 5-14 years or adult respondents. Among children < 5 years, 44·3% experienced stunting, 41·1% underweight, 12.4% wasting, and 26.5% were anaemic. There was self- or carer-reported poor mental health among 16.6% of children aged 5-14 years and 13.9% of adult respondents. Rates of potential risky exposures from swimming in waterways, eating uncooked produce, and eating soil or dirt were high, as were exposures to flooding and livestock. Just over one third of households (35.3%) had access to municipal water, and contamination of well water with E. coli and nitrogen species was common. Most (79·5%) houses had an in-house toilet, but no houses were connected to a piped sewer network or safe, properly constructed septic tank. Median monthly settlement outdoor temperatures ranged from 26·2 °C to 29.3 °C, and were on average, 1·1 °C warmer inside houses than outside. Mosquito density varied over time, with Culex quinquefasciatus accounting for 94·7% of species. Framed by a planetary health lens, our model includes four thematic domains: (1) the physical/built environment; (2) the ecological environment; (3) human health; and (4) socio-economic wellbeing, and is structured at individual, household, settlement, and city/beyond spatial scales.

CONCLUSIONS

Our planetary health model includes key risk factors and faecal-oral exposure pathways but extends beyond conventional microbiological faecal-oral enteropathogen exposure pathways to comprehensively account for a wider range of variables affecting health in urban informal settlements. It includes broader ecological interconnections and planetary health-related variables at the household, settlement and city levels. It proposes a composite framework of markers to assess water and sanitation challenges and flood risks in urban informal settlements for optimal design and monitoring of interventions.

Drinking water provision and quality at the Sahrawi refugee camps in Tindouf (Algeria) from 2006 to 2016

Drinking water provision has been a constant challenge in the Sahrawi refugee camps, located in the desert near Tindouf (Algeria). The drinking water supply system is itself divided in three zones which pump groundwater from different deep aquifers. It is equipped with reverse osmosis plants and chlorination systems for treating water. The allocation of water supplied to the Saharawi refugees for human consumption in 2016 has been estimated at between 14 and 17 L/person/day on average. This supplied water volume is below recommended standards, and also below the strategic objective of the Sahrawi government (20 L/person/day). Yet the local groundwater resources are huge in comparison with estimated consumption, and hence there is great potential for increasing the supplied volume through effecting improvements in the supply system. The physico-chemical quality of the raw and supplied water between 2006 and 2016 has been assessed according to Algerian standards for human consumption. The raw water of two zones of the supply system presents a very high conductivity and high concentrations of chloride, nitrate, fluoride, sulfate, sodium, calcium, potassium and iodide concentrations of natural origin, which may entail health risks. The treatment of water in a reverse osmosis plant greatly improves its quality and osmosed water met the standards. However, the supply of osmosed and raw water needs to be combined in Zone 1, to avoid an excessive reduction in water volume, and the supplied raw water poses a risk to the health of the refugees. The present study provides an example of a drinking water supply system under extreme drought conditions and in the political and social conditions of a refugee camp. Furthermore, it establishes a reference for supplied water allocation and quality in the Sahrawi refugee camps.

Sanitation Infrastructure at the Systemic Edge: Segregated Roma Settlements and Multiple Health Risks in Slovakia

This article explores how multiple health risks in municipalities with Roma settlements in Slovakia are related to the varieties of local governance and the authorities’ conduct towards the local Roma population. The first part of the paper describes the situation in Roma settlements from the perspective of unequal access to sewerage and water pipelines. Introduced here are data on identified contagious diseases that correlated multiple health risks with the lack of sanitation and/or water infrastructure. The second section of the paper put forth typologies of government approaches towards the Roma, which based on ethnographic fieldwork, allows us to identify factors of attitudinal, structural and policy-oriented nature. Research results point to a “triad” of key circumstances: these are the structural conditions in municipalities and the history of local inter-ethnic relations and attitude of authorities towards Roma. Finally, possible solutions and approaches regarding how to mitigate the multiple health risks are discussed. It is suggested that on the one hand, in many villages there is a profound institutional discrimination of Roma with respect to water and sanitation infrastructure; on the other hand, water services are increasingly becoming an expensive commodity that not everyone can afford. The article concludes with discussion on enabling conditions and ways to ensure access to basic infrastructure in rural Roma communities. The solution is not only a compliance with principles of non-discrimination and existing technical norms and standards but also in securing the accessible funding for construction of the sanitation infrastructure in a smart way, including innovations and operation of cheaper and environmentally responsible sanitation technologies.

The construction and examination of social vulnerability and its effects on PM2.5 globally: combining spatial econometric modeling and geographically weighted regression

Fine particulate matter (PM2.5) is of widespread concern, as it poses a serious impact on economic development and human health. Although the influence of socioeconomic factors on PM2.5 has been studied, the constitution and the effect analysis of social vulnerability to PM2.5 remain unclear. In this study, a comprehensive theoretical framework with appropriate indicators for social vulnerability to PM2.5 was constructed. Using spatial autocorrelation analysis, a positive global spatial autocorrelation and notable local spatial cluster relationships were identified. Spatial econometric modeling and geographically weighted regression modeling were performed to explore the cause-effect relationship of social vulnerability to PM2.5. The spatial error model indicated that population and education inequality in the sensitivity dimension caused a significant positive impact on PM2.5, and biocapacity and social governance in the capacity dimension strongly contributed to the decrease of PM2.5 globally. The geographically weighted regression model revealed spatial heterogeneity in the effects of the social vulnerability variables on PM2.5 among countries. These empirical results can provide policymakers with a new perspective on social vulnerability as it relates to PM2.5 governance and targeted environmental pollution management.

Preprocessing alternatives for compositional data related to water, sanitation and hygiene

The Sustainable Development Goals (SDGs) 6.1 and 6.2 measure the progress of urban and rural populations in their access to different levels of water, sanitation and hygiene (WASH) services, based on multiple sources of information. Service levels add up to 100%; therefore, they are compositional data (CoDa). Despite evidence of zero value, missing data and outliers in the sources of information, the treatment of these irregularities with different statistical techniques has not yet been analyzed for CoDa in the WASH sector. Thus, the results may present biased estimates, and the decisions based on these results will not necessarily be appropriate. In this article, we therefore: i) evaluate methodological imputation alternatives that address the problem of having either zero values or missing values, or both simultaneously; and ii) propose the need to complement the point-to-point identification of the WHO/UNICEF Joint Monitoring Program (JMP) with other robust alternatives, to deal with outliers depending on the number of data points. These suggestions have been considered here using statistics for CoDa with isometric log-ratio (ilr) transformation. A selection of illustrative cases is presented to compare performance of different alternatives.

Monitoring inequality in water access: Challenges for the 2030 Agenda for Sustainable Development

The diffusion of the indicators for monitoring sustainable development goals (SDG) has conceptual and symbolic uses far beyond their instrumental uses. Despite its value in dismantling social and economic inequalities, the goal regarding guaranteed of water and sanitation for all did not specify any indicators for this purpose. This research contributes to the discussions on the best way to monitor inequality in access to water by the SDG. Inequality measures established in other areas of study and specific to the access to water were analyzed as their applicability for this purpose. Our study finds that current United Nations strategy does not allow for robust conclusions and does not respect some economical axioms. Furthermore, we show the potentialities and inconveniences of the most important metrics, but it can be concluded that if the objective is merely to measure inequality and communicate easily, the concentration index is the most appropriate measure. These results may contribute to a more refined discussion of how the SDGs can measures progress towards equality in water access and provides information to guide governments agendas for equality in water access.

Increasing latrine use in rural Karnataka, India using the risks, attitudes, norms, abilities, and self-regulation approach: A cluster-randomized controlled trial

Recent years have seen unparalleled efforts by the Swatchh Bharat Mission (SBM) to make India open defecation free. While latrine coverage has been boosted very successfully, latrine use has remained low in many areas of the country. Consequently, the aim of this study was to use robust psychological theory to develop and rigorously evaluate low-cost and scalable behaviour change interventions to promote latrine use in rural India. This study reports findings from a cluster-randomized controlled trial (N = 1945) conducted in rural Karnataka, India, from January 2017 to February 2019. The evaluated behaviour change interventions were developed using the risks, attitudes, norms, abilities, and self-regulation (RANAS) approach. Results showed that latrine use changed by more than 15% in both treatment and control arms. The intervention triggered an additional, statistically significant increase in latrine use of approximately 5% to reach 97% use at endline. The results suggest that external factors had a strong influence on latrine use, with intensive efforts by SBM likely to be among these. The added value of the campaign was to increase latrine use to almost complete uptake and to successfully tackle the most change-resistant individuals. This intervention or selected components could complement future latrine use promotion in India.