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The Global Handwashing Partnership

Moving toward Transformative WASH: Lessons Learned from the 2018 UNC Water & Health Conference

November 26, 2018

By: Aarin Palomares, Global Handwashing Partnership

Every year, the UNC Water & Health conference convenes WASH (water, sanitation, and hygiene) professionals from civil society, government, research institutions, and the private sector to discuss successes in the field, identify current gaps, and ways to move forward as a sector. As a young professional working in hygiene advocacy, I found that the conference provided a platform for all voices to step up to the table, ensuring the sector is more innovative and inclusive in its approach to achieve SDG 6: universal access to sanitation and hygiene for all.

As we reflect on the future of the sector, transformative WASH remains an overarching goal for many WASH researchers and implementers. That is, how can we create enabling environments to not only provide access, but change overall WASH norms? Sessions throughout the conference pointed to the need to shift our work toward more ambitious approaches that go beyond the current status quo. Here are some common themes I heard throughout the conference to push us toward transformative WASH in the future:

Reflecting on “Less Successful Successes”

In recent years, there has been a greater push to present on less successful efforts within the WASH sector. “Less successful successes” were a major theme throughout the conference with Jamie Bartram, Director of the UNC Water Institute, reframing the concept of failure to adapt for learning opportunities that can be gained through missteps. For example, the WASH Benefits and SHINE trials were multi-arm cluster randomized control trials based in Bangladesh, Kenya, and Zimbabwe with the aim to measure the benefits of WASH interventions in improving child growth and development outcomes. Despite being well designed and executed, the trials reported little to no additional effect from WASH interventions on linear child growth compared with nutrition interventions alone.

While the overall body of evidence revealed positive impacts from integrative approaches, these results challenged current behavioral change messaging and highlighted the need to reevaluate our approach and next steps as a sector. A side event convened by World Vision, FHI 360, the Clean, Fed, & Nurtured Coalition, and the Global Handwashing Partnership hosted a discussion based off the WASH Benefits and SHINE trial results. The brief discussion emphasized the need for greater advocacy within the community, stronger governance, and greater frequency in delivering behavior change messages.

The discussion highlighted key considerations for future WASH research. For instance, studies that resulted in a more significant effect had more frequent behavior change messaging to target populations. The role of a community health worker in consistently delivering behavior change tools to target individuals, such as mothers in a community, is crucial and should be considered in future interventions. Based on the discussion, it was clear that these studies call for more integrative interventions with higher levels of intentional WASH needed to sustain impact. To achieve SDG 6 by 2030, we must draw on these conclusions and learn how to incorporate these reflections into future WASH programming.

Social Inclusion

SDG Target 6.2 calls for access to adequate sanitation and hygiene for all, yet it often goes unrecognized that the target emphasizes special attention for the needs of women and girls. WASH issues directly impact gender equality due to the traditional role women play in their homes and in society. As caregivers, women often prepare meals, feed young children, collect water, and manage bathing rituals. These responsibilities lead to a greater need for access to adequate WASH services.

An event convened by the London School of Hygiene & Tropical Medicine, Share, Emory, and Care hosted a discussion on how to create effective policy and practices based on gender-specific needs. While better access to WASH services may improve health and education outcomes, approaches to improve access must challenge the existing stereotype of the woman or girl. As we design programs, we must ask questions rather than make assumptions: What are her needs? Why does she play this role in her family? Does she find joy in what she’s doing? What barriers does she face?

Our discussion focused on gender-specific issues related to food hygiene and child feeding. In this context, a gender-transformative approach not only entails improving access to key WASH services, but also helps communities understand and challenge the social norms that perpetuate inequalities between men and women. This could involve engaging men and boys in ways that support women and girls’ decision making in WASH-related processes. To truly address health inequities, we must include strategies to foster progressive changes in power relationships between women and men moving forward.

Collaboration and Partnerships

Strengthening partnerships and collaboration is crucial to ensure WASH programming is locally appropriate and sustainable. The integrative nature of WASH requires new types of partnerships between research institutions, governments, and private organizations to meet SDG targets. Public-private partnerships, like the Global Handwashing Partnership, leverage different organizational networks and financing mechanisms to achieve one common goal. These collaborative efforts also empower partners to not only be accountable to each other, but to their progress toward SDG targets as well.

The importance of partnerships was further highlighted during several sessions throughout the conference. The plenary session on development effectiveness focused on the Sanitation and Water for All (SWA) collaborative behaviors with focus on planning, coordination, and financing. The integration of WASH with core country systems scales beyond project-based approaches and ensures sustainability. Thus, to achieve universal access to WASH and subsequently the wider SDG agenda, governments must take ownership and strong systems must be in place at the country level. A collaborative decision-making process with accountability mechanisms will ultimately lead to more sustainable, transparent, and transformative solutions.

Moving toward Transformative WASH

Reflecting on my first Water & Health Conference, a quote from Shabana Abas from Aqua for All resonates, “How can we bring different voices into the conversation? How do we get these voices heard at all levels?” If we want transformative WASH, we must first create an enabling environment to host these tough conversations, hold each other accountable, and brainstorm new, innovative ways to grow as a sector. Conferences like this allow stakeholders at all levels to be included in the conversation, bringing science, policy, and implementation actors into one space.

As a sector, we cannot expect different results if we continue business as usual. If we want to meet the SDG targets, we must shift the current trajectory to be more inclusive and create sustainable impact. This requires more practice-relevant research, communication innovations, new partnerships, and better systems management. As we enter a critical period in the SDG era, let us reflect on these lessons learned and move toward transformative WASH together.

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