Including Disabled People in Sanitation and Hygiene Services

The needs of disabled people in developing countries are consistently overlooked when it comes to providing sanitation and hygiene services. This reality has severe and widespread consequences for the health, dignity, education, and employment of disabled people and their caregivers. This briefing note explores these issues and suggests how more and better research could influence policy and improve programmes

Mainstreaming equity and inclusion in WaterAid: an overview of key triggers for success and challenges

WaterAid is an international NGO that has adopted a rights-based approach to reducing inequalities in WASH. WaterAid’s journey to mainstream equity and inclusion in its work began in 2005. Since then it has gained valuable learning about what activities and approaches can propel an organisation along this journey and what can inhibit progress. This paper structures WaterAid’s learning under four stages of an organisational mainstreaming continuum for equity and inclusion, and includes recommendations for organisations travelling along the same journey

Principles and practices for the inclusion of disabled people in access to safe sanitation: a case study from Ethiopia

Disabled people represent the largest socially excluded group and most live without access to basic sanitary services, which can exacerbate impairments and poverty. Nevertheless, they are often excluded from development intervention and research . In response, WaterAid in Ethiopia designed a pilot project to meet the needs of disabled people within their service delivery work. Learning gained through the project informed WaterAid’s global equity and inclusion approach. In 2010, a formative evaluation of WaterAid’s pilot project in Ethiopia was conducted, along with an extensive review of relevant literature, including an assessment of four case studies of World Vision’s projects, semi-structured interviews and participant observation. This paper gives an overview of the research and draws out key principles and practices for development organisations aiming to empower disabled people

Intra-household access to WASH in Uganda and Zambia: do variations exist?

This paper explores intra-household variations in access to WASH through analysis of baseline data from the Undoing Inequity project in Zambia and Uganda. The purpose of which is to explore whether differences exist between head of household and ‘vulnerable’ individuals (disabled, older or chronically ill persons) reports on access and use of WASH at the household level. The results indicate that water indicators reported by the household head e.g. use of the same water source, showed high levels of agreement between the head of household and the ‘vulnerable’ individual. On the contrary, indicators on access to sanitation facilities and consumption of drinking water showed divergence. Indicators on hygiene were found to show poor levels of agreement. These results indicate that there is a specific need to ask particular questions to vulnerable and marginalised individuals themselves in national WASH surveys in order to obtain accurate information to monitor intra-household inequalities

Undoing inequity: water, sanitation and hygiene programmes that deliver for all in Uganda and Zambia- an early indication of trends

This research aims to understand and address the barriers that disabled, older and chronically ill people face when accessing WASH in Zambia and Uganda. A mid-term review was conducted to assess how the approach impacted on the lives of the target group. A process review was carried out to understand how the approach was developed and implemented. Findings demonstrate that the inclusive WASH approach has improved vulnerable people’s WASH access, though barriers still exist. The approach may have had a positive impact on stigma and discrimination, dignity and self-esteem of vulnerable individuals, but older people continue to face disproportionate levels of discrimination due to decreased mobility and ill health. Vulnerable people’s participation in the intervention is lower than expected, though activities to improve this have been identified. This paper captures findings from both reviews, analyses emerging trends and makes recommendations for practitioners attempting to reduce inequalities in WASH access

Translating disability-inclusive WASH policies into practice: lessons learned from Bangladesh

Background: Attention is given to improving people with disabilities access to water, sanitation, and hygiene (WASH) services and providing accessible information in Bangladesh’s WASH-related policies and plans. Yet not all references to disability within these included well-defined activities to achieve them, so policy implementation might not match the identified aims. Methods: This is a qualitative cross-sectional study in Bangladesh’s Gaibandha and Rangpur districts, that aims to explore the implementation of WASH policy commitments to people with disabilities. We purposively selected nine government officials and service providers working in these districts and Dhaka, 15 women and men with disabilities (aged 18-65), and four of their female caregivers living in the districts. In-depth interviews, PhotoVoice and ranking, were applied in person. Data were analysed thematically using Nvivo 12. Results: Government officials demonstrated a solid commitment to disability rights and rehabilitation; they and service providers believed that people with disabilities should have access to WASH services. However, few efforts to improve disability rights included WASH, and few WASH activities systematically included disability. National and district WASH data were not disaggregated by disability, making tracking equitable progress difficult. Few people with disabilities could access or use WASH services independently at home, meaning they did not bathe or use the toilet as often as required and relied on caregivers. Most participants cited affordability as a critical barrier to improving WASH at home. We found examples of Organisations of Persons with Disabilities participating in WASH sector meetings. However, accounts of individuals with disabilities participating in WASH meetings or interacting with WASH organisations were rare. Consequently, very few people with disabilities and caregivers were aware of their right to water and sanitation or had demanded them even though structures exist. Conclusion: WASH and disability are considered and implemented in silos, so many people with disabilities fall through the gap and remain unserved

Foundations of success: driving change through successful research collaborations. Learning Brief.

Translating disability-inclusive WASH policies into practice: lessons learned from Cambodia and Bangladesh was a two-year disability-inclusive research study. It was a collaborative study led by the London School of Hygiene & Tropical Medicine (LSHTM) in partnership with WaterAid and Organisations of Persons with Disabilities in Cambodia and Bangladesh. The research aimed to develop evidence-based guidance for governments in low-and middle-income countries about implementing inclusive water, sanitation, and hygiene at scale. The LSHTM Principal Investigator originally planned to visit each country to guide and mentor the research teams to gather qualitative data in person. The research design changed because of the COVID-19 pandemic and national lockdowns. Instead, the Principal Investigator supported the team from the UK and data was collected remotely. In Cambodia, the Principal Investigator and the research team collaboratively analysed, documented, and disseminated the study. A range of publications was produced, including academic journal articles, accessible briefing notes summarising these, and blogs. Study findings were communicated through virtual and face-to-face workshops, including with people with disabilities and their caregivers who participated in the study. Cambodian actors with disabilities performed key findings and recommendations at the start of workshops to bring the study to life. Recommendations were co-developed with external stakeholders. This Learning Brief documents the process the Principal Investigator followed to remotely support and mentor the research team in Cambodia. The Brief captures the strengths and limitations of approaches and learning gained. It includes recommendations for organisations that remotely support non-academics to conduct ethical research in low-and middle-income countries

Adapting Menstrual Health Interventions for People with Intellectual Disabilities in Emergencies

The Bishesta campaign – a menstrual health intervention for people with intellectual disabilities and their caregivers in Nepal, was developed to help improve menstrual health for this population in non-humanitarian settings (Wilbur et al. 2021a). The campaign was developed by the London School of Hygiene & Tropical Medicine (LSHTM) and WaterAid and delivered in collaboration with the disability service provider, the Down Syndrome Society Nepal, and the Centre for Integrated Urban Development, a local WASH non-government organisation. Following a positive feasibility study (Wilbur et al. 2019a), the Bishesta campaign was ready for efficacy testing or adapting for another context. Due to the lack of attention to people with disabilities’ menstrual health during emergencies, World Vision and the LSHTM adapted the Bishesta campaign for humanitarian responses in Vanuatu and called it the Veivanua campaign. This Frontiers of Sanitation issue presents: the research that preceded the development of these campaigns, the two campaigns, explains the adaptation process, and documents critical considerations for others wishing to revise the campaigns for different settings. This issue will interest practitioners working in menstrual health for people with and without disabilities in the development or humanitarian context.SidaElrha’s Humanitarian Innovation Fund (HIF) programm

Deficiência: Tornar o CLTS Plenamente Inclusivo

CLTS aims at total sanitation. For that it has to be inclusive. There are ethical reasons for this, but the bottom line is that while any open defecation continues, all are affected. This issue of Frontiers of CLTS focuses on people with disabilities and particular needs for access to sanitation. People affected tend not to be present at triggering, to lack voice in the community, to have their needs overlooked, and may even be hidden by their families. This issue outlines the reality of the experiences of disabled people, the varied nature of their needs and how they can be met. It includes practical recommendations for people engaged in CLTS to make the different phases and processes of CLTS more inclusive