Making WASH count

WaterAid UK’s Campaigns Officer Ross Bailey introduces our new briefing paper on the link between WASH and health, and discusses why the health sector must address water, sanitation and hygiene in the Sustainable Development Goals.


14 Nov 2014

With just under a year remaining before UN member states agree the Sustainable Development Goals (SDGs), a lot is still to be decided.

Although the Open Working Group report has outlined a set of draft goals and targets, we don’t yet have a clear view of how these will work together to catalyse action on extreme poverty. In view of the fact that a major criticism of the Millennium Development Goals was the failure to break down silos between development interventions, there’s a lot to be done.

WaterAid has released a short briefing paper (also available in French and Portuguese) on one of the areas in which we see integration as vital – between water, sanitation and hygiene (WASH) and healthy lives. The Open Working Group has outlined a goal and target set for both of these areas, and this paper shows how WASH indicators could be used to monitor whether the right conditions are being established to improve health. Such an approach can reinforce the mutual accountability across sectors, which is necessary to truly impact health and poverty.

The UN Statistical Commission is expected to begin defining indicators next year. WaterAid believes that the post-2015 framework will be successful if indicators for target outcomes (such as rates of child mortality) are accompanied by indicators focused on their determinants (such as WASH).

Karat clinic in Konso, Ethiopia where doctors practice daily without access to clean water.
Karat clinic in Konso, Ethiopia where doctors practice daily without access to clean water.
Photo credit: National Geographic/Lynn Johnson

One good example is the set of indicators that might support target 3.2 in the Open Working Group's report. The target focuses on ending preventable deaths of newborns  and children under five. Globally the second most common killer of children under fives is diarrhoea, which is predominantly caused by inadequate access to WASH.

If we are to end these preventable deaths, there must be a focus on both the diseases and their determinants. An indicator that measures progress on child diarrhoeal deaths might go some way to promoting accountability within health systems. However, this approach alone will not be enough to ensure responsibility, because the determinants of the disease are multisector.

We believe a better framing of the targets and indicators would be to place outcomes – i.e. reduction in the diarrhoeal deaths – alongside their determinants (i.e. access to WASH). Although targets for increasing WASH access and decreasing child mortality would remain under specific goals, the indicators would be bound together by the aim of encouraging responsibility within health systems for non-medical interventions. This would be very much in line with the emerging consensus that Universal Health Coverage should be a target in the post-2015 framework.

Our briefing paper outlines the links between WASH and health, and contains an annex in which we outline four targets for which WASH will be an essential determinant of progress: targets on maternal mortality, child mortality, disease epidemics and Universal Health Coverage. Against each of these we’ve outlined outcome indicators and determinant indicators focused on the impact of WASH.

It’s been said often during the post-2015 discussions that the goals and targets should be simple so that they can be understood by “ministers and mothers”. I couldn’t agree more with that sentiment, but if we don’t build sophisticated, multisector indicators into the goals, we’ll be doing a great disservice to those most in need. Unless we require national health systems to be accountable for safeguarding their population’s health, our advances on delivering healthy lives for all will be limited.

We’re keen to hear what others think of this paper, and welcome thoughts via email to [email protected] or on Twitter @wateraid.

Water, sanitation and hygiene: determining a health goal that works for all

Read Water, sanitation and hygiene: determining a health goal that works for all in English (PDF, 251 KB) >

Lire Eau, hygiène et assainissement : définir un objectif de santé qui profite à tous en français (PDF, 328 KB) >

Ler Água, saneamento e higiene: definição de uma meta para a saúde que funcione para todos em português (PDF, 212 KB) >

Ross Bailey is WaterAid UK’s Campaigns Officer and coordinates our activities on post-2015. He tweets as @rossb82 and you can read more of his blogs here.

For global policy, practice and advocacy updates and discussion, follow @wateraid on Twitter.