People die without clean water. People get sick without effective sanitation - from which they may subsequently die. Nearly 1bn people have inadequate access to safe drinking water and 2.5bn lack adequate sanitation. The problem could not be graver. The root causes of the problems differ. In some cases the problem is a lack of information. Providers of WASH (water, sanitation, and hygiene) goods and services, from soap to the maintenance of water infrastructure, may not be aware of demand in poor communities. Poor people may not demand the services through inadequate communication of the benefits of these services by the providers. There may be an issue with capital to fund the investment in hardware, such as a latrine, for poor consumers. Most likely it is some combination of factors which require a coordinated effort to address.
But donor programmes to address these problems amount to little more than an umbrella in a hurricane. Indeed in some cases, donor programmes have exacerbated the problem by removing any opportunities for the development of a sustainable solution. Gifting of water pumps or toilets, training of maintenance engineers or subsidies to government water systems are all temporary solutions to chronic problems. The justification for these interventions is often technological, focusing only on which of a series of individual interventions has the greatest impact on a target variable in the short term. For example, improvements in water quality have a greater impact than improvements in water supply – more dirty water equals more sick people. But these interventions are never considered in the light of how these interventions were decided upon, how they affect people in the long term, or how they vary by context. They are a one size and one intervention fits all solution.
What happens when the toilet breaks? If co-funding stops, why and how will governments continue with projects? If people are trained in providing a service for which there is a demand, why would they pass that training on? The long-term impacts of WASH interventions should be the principle consideration when assessing efficacy and these impacts are largely determined by the approach taken to determining interventions.
Unless something more fundamental is done which addresses the constraints within the systems that have created these problems, they are destined to continue. Health in development has traditionally being pursued with as a dogmatic quest to replicate Western norms, ignorant of the realities in developing countries. In Guinea, 93% of health expenditure takes place outside of the public sector. If sustainable solutions are to be found to the chronic problems in WASH then there is a need for pragmatism and plurality to overcome the failings of the past (and indeed the present!)
Positive signs can be seen in the work of SC Johnson, international NGO Water for People, and the public sector’s provision of business services to water users associations in Mali that aims to recognise and alter the incentives of producers, consumers, and institutions in the WASH system to improve access to and quality of WASH services for poor people. These attempts, however, are small in number and have stopped short of creating truly sustainable solutions. Further efforts are needed to ensure that we do more than dishing out umbrellas and reverse the rising tide of WASH problems. A det