Poo, Periods and Priorities: what does research tell us about the different views of practitioners, populations and academics about WASH?

April 5, 2022

     By Duncan Green     

Guest post by Roba Aldaour, an Oxfam Public Health and WASH practitioner in Gaza

We recently tried to find out how aid practitioners and affected populations think about Water, Sanitation and Hygiene (WASH) and how they differ in their views. The results of our survey hold important lessons for WASH programmes and their funders around the world.

Unsurprisingly, the top gaps highlighted by the people affected by crisis and practitioners – consulted across 35 countries – were the need for better water supply and provision, sanitation access and coverage, weak hygiene practices and knowledge and poor solid waste management.

But a more interesting pattern emerged from these findings: big differences between practitioners, people affected by crisis and the academic literature on what matters in WASH. Looking at the results in a specific location, Gaza, also highlights that although high level global needs may be similar, locally they take on a unique character and need a tailored response.  

Some examples of the gaps we uncovered:

  • Practitioners v affected populations: Menstrual hygiene management and lack of hygiene materials was a key priority raised by women affected by crises but was not within the top 10 priority gaps identified by WASH practitioners.
  • Solid waste management was a top priority for practitioners and people affected by crisis but did not feature in the top 10 topics examined most frequently in the literature.
  • Lack of water containers, and poor storage practices was a top priority for people affected by crisis but wasn’t mentioned in the top 10 WASH gaps in all of the other interviews.
  • Lack of access to hygiene tools, kits, and products was among the WASH gaps most prioritized by affected populations while it was not within the practitioners’ priorities. At the same time, community engagement was among the priorities mentioned by the WASH practitioners, while it was not identified by all the other views.

How can the findings help us improve humanitarian responses?

Looking at the differences in the way practitioners and people affected by crisis prioritise issues can give us a more nuanced understanding of the gaps in response and how to address them. Practitioners focus more on gaps around systemic issues such as behaviour change and coordination, rather than on the absence or presence of services or materials that are prioritised by people affected.

Rather than representing conflicting priorities we believe these two perspectives are complementary. The gaps highlighted by those affected show the outcomes not being achieved whereas those from practitioners illuminate the structural issues underlying them.

For example, in Gaza the water resources shortage, salinity, and pollution identified by the population are clearly linked to the poor sanitation infrastructure named by practitioners.

What do the global findings mean for localized humanitarian responses?

The study offers insights into the priority needs and preferences of people affected by crises across multiple contexts. It constitutes a starting point for each country to do more to understand the various root causes and gaps that will lead to more informed and appropriate solutions.

So what are the priority gaps in WASH systems and the best responses?

Despite the simplicity of this question, it is very difficult to answer in places where people lack access to the most basic WASH services. In the Gaza Strip, the affected population sees all WASH services as top priorities. This is the reality, the people there live in deteriorating social and economic conditions due to the Israeli occupation, political division, siege, recurrent aggressions, and WASH infrastructure demolition.

Specifically, the research findings in the Gaza strip demonstrate that the first two prioritized gaps for the affected population and WASH practitioners are poor access to safe and adequate water and insufficient sanitation infrastructure, mainly drainage system for waste water and rain water These two priorities in Gaza were also the top gaps identified by people affected by crisis around the world, despite efforts made for decades to improve people’s access to water and sanitation services.

The provision of water and sanitation is multi-dimensional and influenced by weak governance and regulatory frameworks, underdevelopment, poor access to basic services, climate change and environmental components, which all affect the delivery and sustainability of services.  That means we must be smart, put the affected people in the center and let our hands intertwine in planning, responding and learning together. So although the gaps are the same as the global findings, filling those gaps requires context-specific interventions underpinned by an in-depth understanding of the root causes of the problems in that context.

For example, guaranteeing a sewage system has to be linked with waste water management actions from collection, treatment and reuse to the financial and institutional/governance management that will ensure proper operation and maintenance. But to do that institutional management in a context of conflict and divided government, you need to understand the context in-depth to come up with proper solutions that will be suitable for these contexts.

Where to go from here?

Everyone has a role to play: the donors through facilitating the alignment among agencies; supporting WASH national and international agencies, community based organizations and service providers in building better systems of monitoring and accountability around the provision of these services to gain more actively solicited feedback from field practitioners and affected populations and understanding the contextual root causes that need to be considered for the other WASH gaps.

For example, water supply in Gaza, as in other areas in conflict, should include water quality monitoring, safe water handling and legal water governance, while hygiene promotion should be designed to consider menstrual hygiene management, such as access to dignified hygiene materials and proper awareness messages. And finally, all WASH responses should be supported by effective and inclusive hygiene promotion campaigns and community-based structures.

Let’s connect & talk more, seek improvement, seize opportunities, and hold ourselves accountable.

April 5, 2022
Duncan Green