7 ideas on how knowledge can help us achieve universal access to safely-managed drinking water and sanitation

It is vital that we better manage our knowledge, to make better use of it for delivering universal access to water and sanitation. This requires new ways of capturing, sorting, weighing, curating, and translating knowledge into practical, bite-sized chunks. The Disease Control Priorities project, now in its third edition (www.dcp-3.org), is an excellent example of what this looks like in practice. It aims to compile the best available evidence across multiple areas of health to provide a snapshot of the coverage of services, the problems resulting from lack of services, the effectiveness of interventions, and the cost-effectiveness and cost-benefit of those options.
 

Disease Control Priorities Network (DCPN), funded in 2010 by the Bill & Melinda Gates Foundation, is a multi-year project managed by
University of Washington’s Department of Global Health (UW-DGH) and the Institute for Health Metrics and Evaluation (IHME). 


As authors of the WASH chapter of DCP-3, we wanted to share some of our key takeaways below:

1. The transition from MDGs to SDGs has not been an easy one.
The goalposts have shifted for water, sanitation and hygiene (WASH) with significantly more ambitious targets whose end date is only 12 years away. Given an annual financing gap of tens of billions of dollars for WASH alone, we need to continually innovate and manage our knowledge better, leading to more efficient and sustainable approaches to delivering WASH services. But reaching the last mile – isolated, poor and vulnerable populations – presents particular challenges for getting to universal access, especially when considering the higher ‘safely managed’ standards which countries are now grappling with.

2. But there are many reasons to be hopeful.
We can find encouragement in the achievements of countries such as Thailand, Malaysia, and Chile who are nearing universal WASH coverage, Singapore’s steps towards closing the water cycle, India’s commitment at the highest political levels to end open defecation by 2019, and large-scale sanitation programmes reaching the poor and vulnerable in Tanzania, Ethiopia and Indonesia, among other countries. These examples show that rapid and sustained progress is possible given political commitment, dedicated resources and adequate and incentivized human resources.

3. Disaggregated data are key: we need to understand heterogeneity.
The quality of WASH facilities varies widely between the poor and non-poor, and between the urban and rural areas in many countries. The World Bank’s WASH Poverty Diagnostic Initiative provides an in-depth look at some lesser known differences across 18 countries. For example, in Indonesia and Bangladesh there are striking differences across neighbourhoods in the same city, while in Tajikistan households in the Sughd region have piped water just 1 day a week. Disaggregated data on the underserved—including slum populations, ethnic groups, women, children, elderly, and persons with disabilities can inform allocation decisions and reduce inequalities. 

4. Multi-sectoral approaches are key, requiring coordination and convergence.
Access to improved water, sanitation and hygiene behaviours underlie early child nutrition and development, helping to fortify human capital and economic growth. But these interventions by themselves are not sufficient – convergence is needed. That means approaches that deliver quality WASH services, must be coordinated alongside critical health, nutrition and food security interventions to communities suffering from high rates of chronic malnutrition.

5. We need greater finesse in our behaviour change approaches given context specific attitudes, practices, social and cultural influences.
Behavior change is rarely achieved through conventional methods, nor is it easily transferable. This matters because policy makers are increasingly looking to the behavioural sciences for clues about how human behaviour departs from the expected in systematic ways. The idea that subtle, non-intrusive interventions – what Nobel Prize Winning Economist Richard Thaler calls ‘nudges’ – can lead to interventions that are effective in a variety of contexts is gaining traction. 

6. Financing needs to be ‘smart’ and better targeted to the needy.
Many WASH interventions, such as water filters, piped water, boreholes, and private latrines, are cost-effective, but don’t always reach the extreme poor. Conditional-cash transfer (CCT) programs can provide the methodology and data sources to support poverty targeting of WASH services, enabling subsidies and financing to reach those who would benefit the most. These programs provide a platform to reach target households with sanitation promotion messages. 

7. We need methodologies and tools to allow regular updating of sector knowledge, rather than one-off studies.
Traditionally, research syntheses such as literature reviews and meta-analyses have provided the latest view on key topics. But with new evidence released daily, these syntheses quickly become outdated. The rapidly expanding knowledge base from more institutions working in WASH, more academic papers and more databases requires us to be smarter about the way we generate and manage knowledge, necessitating greater collaboration across institutions and across countries. One particularly effective model is the Cochrane Collaboration which synthesises health impact evidence and encourages periodic updates of meta-analyses as new studies become available.
 

As knowledge accelerates and changes in its nature, we need new approaches to knowledge management to ensure we are using what we know wisely, free from information overload and risks of bias – especially if we are to accelerate towards delivering on the SDGs.
 

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