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Moving beyond the artificial divide

Published on: 11/05/2021

How we can bring WASH and health back together

Photo: Emory University Center for Global Safe WASH

Guest blog by Lindsay Denny

Since the start of the COVID-19 pandemic, there is one mantra that has been repeated in public health messaging around the world: “Wash your hands”. When it comes to disease prevention, particularly when dealing with novel pathogens, handwashing is one of the most important public health measures. And this is by no means new – Florence Nightingale was a champion of the practice in the 1800s.

In modern times, WASH has been shown to be an excellent vehicle for addressing some of the most important health threats faced by low and middle-income countries. WASH is the primary mechanism by which we interrupt the fecal-oral cycle and prevent diarrheal diseases like cholera, which can bolster vaccine campaign efforts and in the long term can improve child nutrition. Additionally, safe WASH services are critical in preventing neglected tropical diseases like trachoma and schistosomiasis through safe sanitation and access to hygiene. In the healthcare setting, with the high density of vulnerable patients and pathogens, safe healthcare delivery is contingent upon a hygienic environment. Efforts to curb antimicrobial resistance include a strong emphasis on preventing infections first rather than treating them – another area where WASH has been identified as a key priority. With rapid urbanization and climate change affecting much of the world’s population, the impact of WASH on health will continue to grow.

All of this is to say: clearly, we need WASH and health to work together. However, when it comes to international development, WASH and global health have been split into two sectors with distinct agendas. Perhaps this is because WASH is a public works solution to a myriad of health problems. Or perhaps it reflects the broader issue of silos within global health. Whatever the reason, the artificial divide does not benefit the ultimate goals we are both working toward: to prevent illness and death and to improve quality of life.

What do we need to know about one another? For health colleagues, WASH is most sustainable when we take a systems approach. This means that focusing simply on the intervention -- digging a borehole or organizing a handwashing training -- is unlikely to lead to long-term improvements in health on their own. Designing programs with the key building blocks in mind, like policies and financing, will go a long way in making sure your interventions are good investments. Operations and maintenance are similarly crucial to program success.

For WASH colleagues, gaining a better understanding of the global health landscape is an important place to start. Global health has been disease- or cause-specific for some years, though there has been a push recently for a more integrated approach. In this sense, the focus on system strengthening reflects a similar evolution that WASH is undergoing. However, much of the funding remains tied up in these disease silos. Learning the language of global health and articulating specifically how WASH interventions can be supportive of health programming would fast forward the process of integration and prioritization.

To begin to work more productively with one another, both WASH and global health practitioners will need to reach beyond our usual partners. WHO’s WASH and NTD toolkit provides a framework of how the two groups can work more closely together. We need to make more room at the table. We need to champion one another’s issues. And most importantly, we need to advocate for a more inclusive approach to global health programming that considers WASH a valuable means by which to prevent a number of diseases. Because as John Snow, father of public health, knew 150 years ago – WASH is foundational to health.

Lindsay Denny is the health advisor for Global Water 2020, overseeing the WASH in healthcare facilities portfolio. The daughter of a plumber, she is a strong advocate for greater integration of the WASH within global health.

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