Concept and features of WASH
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The library doesn't have a dedicated WASH section, but Park's Textbook of Preventive and Social Medicine has detailed coverage on water, sanitation, and hygiene as separate components. I have enough from the web sources and the textbook to provide a thorough answer now.
WASH: Concept and Features
What is WASH?
WASH is an acronym for Water, Sanitation, and Hygiene - a global public health framework that groups these three interconnected domains together because of their combined impact on health outcomes, particularly the prevention of infectious diseases. The term is used as shorthand for a wide array of infrastructure, behavioural, and policy interventions aimed at increasing access to water and sanitation services and promoting good hygiene practices.
WASH is applied primarily in households and public settings (schools, healthcare facilities) in low- and middle-income contexts where access remains limited due to poverty, inequality, insufficient public funding, and geographic barriers.
The Three Core Components
1. WATER (W)
Safe water is the foundational pillar of WASH. Water intended for human consumption must be:
- Free from pathogenic agents (bacteria, viruses, parasites)
- Free from harmful chemical substances (arsenic, fluoride, nitrates)
- Organoleptically acceptable - free from colour, odour, and unpleasant taste
- Usable for domestic purposes in adequate quantity
Key facts:
- Basic physiological requirement: ~2 litres/person/day (survival minimum)
- Adequate public health supply: 150-200 litres/capita/day (urban); 40 litres/capita/day (rural, India target)
- Approximately 2.2 billion people globally still lack access to safely managed drinking water
- Unsafe water causes diarrhoea, cholera, typhoid, hepatitis A, and other waterborne diseases
Uses of water in a community include domestic (drinking, cooking, bathing), public (street cleaning, recreation), industrial, agricultural (irrigation), and waste carriage purposes. - Park's Textbook of Preventive and Social Medicine
2. SANITATION (S)
Sanitation refers to the management of human excreta and the broader environment to prevent disease transmission. It includes:
- Toilet/latrine access - improved facilities not shared with other households
- Safe disposal of excreta - in situ or through off-site treatment
- Ending open defecation (OD) - a key SDG target
- Solid waste management
- Wastewater treatment and drainage
JMP "Service Ladder" for sanitation (WHO/UNICEF Joint Monitoring Programme):
| Level | Description |
|---|---|
| Safely managed | Improved facility, not shared, excreta safely disposed/treated |
| Basic | Improved facility, not shared |
| Limited | Improved facility, but shared |
| Unimproved | Pit latrine without slab, hanging latrine |
| Open defecation | No facility |
Key facts:
- ~4.2 billion people lack safely managed sanitation
- ~2.3 billion lack even basic sanitation
- Open defecation contaminates groundwater and surface water, creating cycles of disease and poverty
3. HYGIENE (H)
Hygiene refers to practices that maintain cleanliness and prevent the spread of disease. Key areas include:
- Handwashing with soap and water - the single most effective hygiene behavior for preventing diarrhoea and respiratory infections; WASH interventions increase handwashing by up to 50%
- Menstrual hygiene management (MHM)
- Food hygiene - safe preparation, storage, handling
- Household water treatment (boiling, chlorination, filtration)
- Personal hygiene - bathing, oral care
- Environmental hygiene - maintaining clean surroundings
SDG Indicator 6.2.1(b) measures the proportion of the population with a handwashing facility with soap and water available at home.
Key Features of WASH
| Feature | Description |
|---|---|
| Interdependence | The three components reinforce each other - safe water is useless without hygiene practices; sanitation without handwashing leaves disease pathways open |
| Human rights basis | Access to safe water and sanitation is recognized as a fundamental human right (UN, 2010) |
| Disease prevention | WASH prevents diarrhoeal diseases, cholera, typhoid, soil-transmitted helminths (STH), schistosomiasis, trachoma, and other neglected tropical diseases (NTDs) |
| SDG alignment | Linked to SDG 6 (clean water and sanitation for all by 2030) and SDG 3 (good health) |
| Equity dimension | Women and girls disproportionately affected by poor WASH - they bear the burden of water collection and face safety risks from inadequate sanitation; WASH improves girls' school attendance |
| Economic impact | Improved WASH reduces medical costs, increases labour productivity, and reduces school absenteeism |
| Multi-sectoral | WASH intersects with nutrition, education, gender equity, climate resilience, and community development |
| Settings-based | Applied at household, school, healthcare facility, and community levels |
WASH and Disease Burden
Poor WASH is a major driver of preventable illness:
- Diarrhoeal disease mortality was halved during the MDG period (1990-2015) largely due to WASH improvements
- WASH interventions reduce diarrhoea morbidity by 40% and waterborne infections by 25% (post-intervention studies)
- Water purification reduces waterborne pathogen prevalence by up to 60%
- Open defecation elimination reduces fecal-oral disease transmission dramatically
- Poor sanitation and overcrowding together favour water-borne and food-borne epidemics - Park's Textbook of Preventive and Social Medicine
WASH in Global Frameworks
- SDG 6: "Ensure availability and sustainable management of water and sanitation for all"
- Target 6.1: Universal access to safe, affordable drinking water by 2030
- Target 6.2: Access to adequate sanitation and hygiene; end open defecation by 2030
- SDG Indicator 3.9.2: Mortality rate attributed to unsafe WASH
- WHO/UNICEF Joint Monitoring Programme (JMP): Monitors global WASH progress using service ladders
- 94% of countries have national policies for drinking water and sanitation; 79% have hygiene policies (yet most lack human resources to implement them)
WASH and Neglected Tropical Diseases (NTDs)
WASH plays a central role in preventing NTDs including:
- Trachoma (requires face washing and environmental sanitation)
- Soil-transmitted helminths (ascariasis, hookworm, trichuriasis) - require improved sanitation
- Schistosomiasis - linked to unsafe water contact
- Cholera, typhoid, hepatitis A - classic waterborne diseases
According to the WHO WASH page, safe and sufficient WASH plays a key role in preventing these diseases and contributes to livelihoods, school attendance, dignity, and resilient communities.
Summary
WASH is not merely about infrastructure - it is a framework that links physical access (pipes, toilets, handwashing stations) with behaviour change (hygiene promotion, community education) and governance (national policies, monitoring systems, financing). Its ultimate goal is to break the chain of disease transmission through safe water, contained excreta, and clean hands - achieving measurable improvements in child survival, maternal health, nutrition, education, and overall human development.
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