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Water, Sanitation, and Hygiene: a big deal, a package deal

Published on: 03/10/2014

This blog, written in the context of Burkina Faso, sets out how the lack of integrated approaches to WASH is one of the limiting factors in achieving universal access to WASH services. National policy makers and donor agencies insufficiently take the one-package WASH advantages into account, with development programmes thereby insufficiently focusing on aspects of sanitation and hygiene.

Looking at the Millennium Development Goals' targets related to water and sanitation, it is well-known within the WASH sector that the world met the target of halving the proportion of people without access to improved sources of water, five years ahead of schedule. Nonetheless, we remain immensely off-track when it comes to meeting the same target for sanitation- we are set to miss the target by more than half a billion people worldwide- whilst the hygienic use of these facilities has not even been taken into account. Not only has the world been so focused on increasing coverage through the construction of pumps and other equipment, thereby completely disregarding aspects of maintenance and management, but we have also been able to observe a marginalization of the other two WASH components, sanitation and hygiene, in the list of water-related priorities. Clearly, the message of the benefits of WASH as a package deal has not come across, not at the global level, and in a great deal of cases, not at a country level either. These same patterns are reflected in Burkina Faso, a country which generally ranks low in water and sanitation service delivery, and where we can observe patterns that indicate a serious neglect of sanitation and hygiene.

Burkina Faso actually faces a double challenge in achieving universal WASH access throughout the country, which comprises finding a solution regarding the huge gap between urban and rural service delivery, as well as attaining enough funds and commitment for the WASH sector to move forward as a whole. In urban areas, there is a 86% coverage of water service delivery, compared to a 63% coverage in rural areas (INO, 2013). In the case of sanitation, 29%  of the urban population has access to sanitation services, and only around 6% have access to these services in rural areas (DGAEUE, 2013). In order to truly put this into context, it's important to realize that Burkina Faso's society is largely a rural one, with about 77% of the population living in rural areas.

As was pointed out by IRC Burkina Faso's country Director Juste Nansi, during the recent workshop on aid effectiveness in the WASH sector held in Ouagadougou, given the large percentage of Burkina Faso's rural population, not a person in the country can live oblivious or unaffected by the current situation. Yet, the research carried out by IRC in the period of 2008-2014, demonstrated that not only is it more difficult to acquire the funds that match the needs for sanitation as opposed to water, it is even more difficult to do so for rural areas as opposed to urban areas. With the water accessibility relatively on track with respect to the 2015 targets (in urban areas more so than in rural areas), the study demonstrates very poor results for sanitation, with urban areas off by about 17% from the projected target, and with rural areas off by 37%. And what about hygiene? The hygienic use of these facilities was, once again, not even taken into account when the targets were set.

We must realize that the advantages to having access to water services are at their highest once we go for the entire WASH package, meaning that only in combination with adequate sanitation and hygiene, can water truly live up to its reputation as a source of life. Indeed, all too often, people with access to water can be prone to all sorts of water-borne diseases if there are no adequate sanitation facilities available. UN figures estimate that 80 per cent of diseases in developing countries are related to poor WASH access, with inadequate sanitation facilities at the root of many of these diseases. Open defecation is said to be one of the main causes of diarrhea, which worldwide results in the deaths of more than 750,000 children under the age 5 each year. Burkina Faso does not make an exception to these figures, where over 12,000 children under five years old die annually from poor water and sanitation. Additionally, recent evidence suggests that even if one household has adequate water and sanitation facilities, a neighbor that continues practicing open defecation can be just as hazardous to one's livelihood, demonstrating once again that the importance of sanitation should not be underestimated.

When it comes to hygiene, most WASH experts will agree that hygiene promotion is a vital component to any successful WASH intervention. Nonetheless, in practice, hygiene hardly ever takes a prominent role in WASH policy-making. But think about this: how can we fully benefit from the availability of water if we don't properly wash our hands after using the toilet and before handling food? And what use is it having a toilet when we don't have proper menstrual hygiene facilities, if we don't ensure fecal containment and management, or if we simply prefer to just take our business outside? Since hygiene promotion is about changing behaviors, attitudes, and preferences, at the end of the day, this means that this is much more challenging than merely delivering water pumps and latrines.

Although the immense efforts to mobilize and accomplish water and sanitation targets throughout the past years should most definitely not be downplayed, we are still extremely far from achieving sustainable and universal water, sanitation, and hygiene services for everyone. Now that the post 2015 targets are to be set, both at the global and at the Burkinabe level, we must truly reflect on what needs to be achieved if we want to improve people's well-being in relation to water. Although the challenges are many and extremely varied, one important factor to take into account is that post 2015 water and sanitation goals must be better designed in order to ensure the sustainability of interventions. This means that, besides making sure that maintenance and management procedures are established for the sustainability of services, the targets should encourage an integrated approach to water, sanitation, and hygiene. This is essential in order to stimulate national policy makers, donor agencies, and other important actors to invest in coordinating aspects of water, sanitation, and hygiene so that future WASH programmes include the important element of a hygienic use of water and sanitation facilities, rather than merely focusing on increasing the coverage rates of these facilities. It is important to realize that now is also the time to reflect on what hasn't been achieved, in order to find a way to address and correct the discrepancies in the allocation of money and commitment, such as the persisting poor WASH situation in rural Burkina Faso clearly demonstrates.

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