Exploring disability-inclusive water, sanitation and hygiene in Bangladesh and Cambodia

As the world celebrates International Day of People with Disabilities on 3 December, it’s important to understand why people with disabilities have difficulty accessing essential water, sanitation and hygiene (WASH) services. We know there is a growing focus on improving and including disability in WASH policies and services, but how do we know if this is actually making a difference?

WaterAid collaborated with the London School of Hygiene and Tropical Medicine (LSHTM) to explore exactly how commitments to disability-inclusive WASH have been made by national governments in Bangladesh and Cambodia, and how these are leading to more inclusive WASH services. The study – Translating disability inclusive WASH policies into practice: lessons learned from Cambodia and Bangladesh (2019–2022) – aimed to come up with evidence-based guidance for governments in low- and middle-income countries (LMICs) about disability-inclusive WASH.

People with disabilities’ rights to WASH access are often understood but not enacted.

The study reached a total of 65 participants, including 31 people with disabilities.  

In Bangladesh, the research found that government officials and service providers believed that people with disabilities should have access to WASH services, but efforts to improve disability rights rarely took WASH into consideration. Few people with disabilities could access or use WASH services independently at home, meaning they could not use the toilet or bathe as often as needed and had to rely on caregivers. Most participants explained they could not afford to improve the WASH situation at their home. Very few people with disabilities and caregivers were aware of their right to water and sanitation, or the systems that exist for them to demand it.

No one ever talks with me or [person with disabilities] […]. Nobody talks with us about WASH, sanitation or disability

-Caregiver of a woman with a hearing and communication disability, Bangladesh

In Cambodia the research found that there were policy commitments to disability- inclusive WASH, but these policies were not always followed through at all levels. Organisations of Persons with Disabilities faced challenges when advocating for disability rights at WASH sector meetings, and people with disabilities were inconsistently supported to participate in WASH meetings. Poor access to assistive devices (e.g., wheelchair) and inaccessible terrain meant few people with disabilities could leave home and many had inadequate WASH services at home. Caregivers did not have assistive devices (e.g., commodes, bedpans) or products (i.e., lifting devices), so supporting WASH for people with disabilities was physically demanding and time-consuming.

Participant: “I want a bigger toilet so that the wheelchair can go in and stuff, but I do not have the money.”

Researcher: “I see. You do not install a railing?”

Participant: “No, where can I get the money for that when I do not have any money?”

- Man with a physical disability, Cambodia

The findings from this research have been widely shared in Cambodia and Bangladesh through events, workshops, and creative films. This has increased awareness among duty bearers (including service providers) about the WASH access of people with disabilities and caregivers, how it can be improved and the power and value of ensuring people with disabilities are at the front and centre of WASH progress.

The project also led to improved collaboration between WASH, disability and health actors, as well as increased the amount of people with disabilities participating in WASH conversations and solutions. It also enhanced the skills of disability and WASH practitioners with and without disabilities to carry out scientific research.

Publications and full learning materials of the research can be found here. 

Report written by: Chelsea Huggett,  Jane Wilbur, Rithysangharith Has, Mahfuj-ur Rahman