Background: Three large new trials of unprecedented scale and cost, which included novel factorial designs, have found no effect of basic water, sanitation and hygiene (WASH) interventions on childhood stunting, and only mixed effects on childhood diarrhea. Arriving at the inception of the United Nations' Sustainable Development Goals, and the bold new target of safely managed water, sanitation and hygiene for all by 2030, these results warrant the attention of researchers, policy-makers and practitioners. Main body: Here we report the conclusions of an expert meeting convened by the World Health Organization and the Bill and Melinda Gates Foundation to discuss these findings, and present five key consensus messages as a basis for wider discussion and debate in the WASH and nutrition sectors. We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health. Conclusion: These results are important because such basic interventions are often deployed in low-income rural settings with the expectation of improving child health, although this is rarely the sole justification. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, in so much as it encapsulates the guiding principle thatin any contexta comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden.
Improvements of water, sanitation, and hygiene (WASH) infrastructure and appropriate health-seeking behavior are necessary for achieving sustained control, elimination, or eradication of many neglected tropical diseases (NTDs). Indeed, the global strategies to fight NTDs include provision of WASH, but few programs have specific WASH targets and approaches. Collaboration between disease control programs and stakeholders in WASH is a critical next step. A group of stakeholders from the NTD control, child health, and WASH sectors convened in late 2012 to discuss opportunities for, and barriers to, collaboration. The group agreed on a common vision, namely “Disease-free communities that have adequate and equitable access to water and sanitation, and that practice good hygiene.” Four key areas of collaboration were identified, including (i) advocacy, policy, and communication; (ii) capacity building and training; (iii) mapping, data collection, and monitoring; and (iv) research. We discuss strategic opportunities and ways forward for enhanced collaboration between the WASH and the NTD sectors.
This policy brief sets out key concepts, principles and practical implications for the citywide inclusive sanitation (CWIS) approach. Rapid urbanization, aging infrastructure, and climate change are exacerbating a sanitation crisis. The focus of most urban sanitation interventions remains incremental expansion of centralized sewer infrastructure; little attention is paid to reaching the poor, long-term service provision, financial viability, or the public system functions required to achieve those outcomes. Meeting SDG targets requires a radical rethink of the urban sanitation sub-sector. CWIS offers this. This paper presents a public services framework, set out by the Gates Foundation, for pursuing equitable, safe and sustained service outcomes, at city scale. It reviews the genesis and evolution of the CWIS framework and shares key principles and policy implications.
Concerns about enduring low rural sanitation coverage figures in Cambodia prompted a series of studies providing insight into overall sector performance, sanitation demand and existing supply chains. Findings from the research led to the formulation of a sanitation marketing pilot aiming to make affordable, desirable latrines available through market channels. Option design, contractor training, awareness raising and marketing are the main components of the programme, implemented in two provinces. To date (22 months since inception) the project has resulted in a branded, low-cost pour-flush latrine sold by trained suppliers, who have sold more than 7,400 units. Planned next steps include expanding technology choices (still lower costs, and/or suitable for challenging physical circumstances), developing stronger linkages with micro-credit schemes and developing approaches for scaling up the approach.
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