What is WASH?
WASH is an abbreviation that stands for water, sanitation and hygiene. The acronym has become popular during the last couple of decades as the focus on providing safe water supply, sanitation and hygiene to the global population has been growing. (Note that sometimes WASH is written with a small ‘a’, WaSH, from water, but the meaning is the same.)
The combination of water, sanitation and hygiene into one term recognises that the three are closely linked and should be considered together. However, before looking at their connections, it is important to understand their individual meanings. Box 1.1 provides some definitions of several key terms.
Box 1.1 Some important WASH definitions
Water supply is the provision of water by public utilities, commercial organisations, communities or individuals. Public supply is usually via a system of pipes and pumps. In order to sustain human life satisfactorily, a water supply should be safe, adequate and accessible to all.
Safe water supply means the supply of water is free from any form of disease-causing agents. The main criteria are:
- biological aspects: the water supply should be free from disease-causing microbes and parasites.
- chemical aspects: the water supply should be free from dissolved chemicals at the level that would damage health.
- radiological aspects: the water supply should be free from any naturally occurring radioactive substances.
In addition to being safe, the water must also be acceptable to consumers by being odourless, colourless and without objectionable taste.
An adequate water supply fulfils the minimum amount of supply per person per day. The World Health Organization defines this amount as 20 litres of water per person per day. (Note that ‘per person’ is sometimes written as ‘per head’ or ‘per capita’ – they all mean the same.)
Accessible water supply is within safe physical reach from the home or institution, usually within 1 km or a 30-minute round trip.
Sanitation generally refers to the prevention of human contact with wastes, but is also used to mean the provision of facilities and services for the safe disposal of human urine and faeces. Sanitation can be further classified as basic or improved sanitation.
Hygiene: the word hygiene originates from the name of the Greek goddess of health, Hygieia. It is commonly defined as a set of practices performed for the preservation of health and healthy living. Handwashing with soap or ash is the most important element, but it also includes personal cleanliness of the face, hair, body, feet, clothing, and for women and girls, menstrual hygiene.
Before the term WASH became popular, various other abbreviations such as WATSAN (water and sanitation) and WES (water and environmental sanitation) were used. These acronyms acknowledged the link between water and sanitation but, in practice, these two basic services were generally not considered as a package. The tendency was to consider them separately (either water or sanitation), one service at a time. Furthermore, in these older acronyms, the ‘H’ for hygiene was missing. This reflected a common approach that did not recognise the connections between the three services.
An example of how the missing hygiene component has negatively affected the intended impact of projects can be found in some regions of Ethiopia where trachoma is a problem. Trachoma is a bacterial infection of the eye that causes pain and irritation and can lead to blindness. It is spread by direct or indirect contact with an infected person and is associated with poor personal hygiene and lack of washing. In some parts of Ethiopia, although many water supply projects have been completed, it is common to see people, especially children, with dirty faces. Unwashed faces and eyes encourage the infection and despite the improved water supply, the prevalence of trachoma in some locations has remained unchanged for many years. This implies that people are not using the water for hygiene purposes, even though it is easily available. If hygiene promotion had been included with the improvements to water supply, the situation may be very different.
After many years of unsuccessful efforts to raise awareness of the connections between water, sanitation and hygiene by governments, non-governmental organisations (NGOs) and United Nations (UN) agencies such as UNICEF, the term WASH as a combination of the three inseparable elements has gradually become popular and is now recognised at all levels.
Improvements in water and sanitation
The goal of water and sanitation projects in Ethiopia and throughout the world is to bring benefits to the lives of people by improving the supply of safe water and access to sanitation. Assessing the status of water and sanitation provision and measuring improvement requires a standardised set of definitions of the different types and levels of service. The Joint WHO/UNICEF Monitoring Programme (JMP) is mandated to give globally recognised definitions to the terms. Figure 1.1 clarifies the terms and presents them as ladders of improvements in water and sanitation.
Figure 1.1 uses the terms ‘drinking water ladder’ and ‘sanitation ladder’. What does the concept of a ‘ladder’ mean to you and why do you think it is used in this way?
A ladder is equipment for climbing from one level to a higher level by a sequence of rungs or steps. The use of ‘ladder’ in describing water supply and sanitation indicates that there is a progression from the basic unimproved provision in a sequence of steps up to improved services at the top of the ladder.
The idea of the ladder provides a useful measure of progress. Imagine you were employed as a community WASH worker with responsibility for promoting WASH improvements in your community. How do you think you might use the ladder concept in practice? You would need to start your work by collecting data about the WASH services that the community is using before you begin your promotional work. Once you have gathered this data, by using your knowledge of the sanitation and water supply ladders, you can identify where the majority of people are placed on the ladder. This will enable you, in collaboration with other partners, to come up with a plan to move the community members up the ladder.