Water, sanitation and hygiene (WASH) and NTDs

Access to water and sanitation, and the practice of good hygiene, are critical to the management, prevention, control, and elimination of a number of NTDs, including trachoma, leprosy and schistosomiasis.

This year the NGDO NTD Network (NNN) meeting dedicated its
first day to WASH and NTD issues, focussing on implementable collaboration practices. The aim was to advance the dialogue between WASH and NTD stakeholders from rhetoric to action, looking at what’s worked and what needs to change, examining evidence, and sharing emerging tools for mapping and data collection. Discussions drew upon case studies to emphasise success factors that enable collaboration. The session sought to solidify collective action around the following themes:

Cross-sectoral collaboration and joint programme delivery

A strong focus on equity, rights and rights-based approaches and ensuring that programmes deliver for everyone in a community can help drive collaboration. This focus helps WASH and NTD to begin to coordinate efforts (co-implementation of programmes in endemic areas) and, when necessary, move towards joint planning and programme delivery. Achieving control and elimination of trachoma, for example, requires the full implementation of the SAFE framework (surgery, antibiotics, face-washing and environmental improvement).

The successful Ghana Trachoma control programme involved joint planning, implementation and monitoring between WASH and NTD actors, as well as sharing of national data to drive innovative approaches such as inclusion of trachoma in school curricula. The establishment of a strong national task force with full representation of health and WASH stakeholders was a key success factor. The confidence of all parties in the SAFE strategy drove commitment and collaboration among stakeholders and other disease programmes to achieve impressive outcomes including a reduction in the prevalence of trachoma from 9.7 -16.1% to less than 3.0% in endemic districts between 2000 and 2010.

Shared data collection

There remains a dearth of rigorous research on the link between WASH and NTDs. The presence of NTD programmes within marginalised populations (e.g. through community based MDA) can support shared data collection on WASH access as well as NTD data. This also allows for joined advocacy to ensure that poor and marginalised communities gain access to key services. Research and mapping data are vital to building an evidence base to inform disease control programmes, and mobilize stakeholders to participate in coordinated action for mutual benefit.

The Global Trachoma Mapping Project shows the NTD community's strength in mapping, and the survey it uses includes basic questions on WASH access that capture data on access to water for face-washing and access to sanitation facilities. The bedrock of this project has been standardisation of the data collected by GTMP with the type of data gathered on access to water and sanitation through existing surveys. Such initiatives contribute to the evidence base by tying together household-level disease and WASH data and ensuring that interventions can be prioritised and targeted.

WASHING away morbidity and disability

For NTDs such as Lymphatic Filariasis and Leprosy, WASH is a vital component of care and a means to promote social inclusion. WASH represents a critical component of community-based care for Lymphatic Filariasis and Leprosy in order to address risk factors such as poor hygiene, which exacerbates lesions and infections that lead to disability. Further, people living with disabilities are often subjected to stigma and inclusion, and the session highlighted examples where inclusive water and sanitation programmes can address such stigma and provide much needed access to these basic services. This demonstrates the value of WASH to NTD programmes beyond disease control.

The meeting called for joint, coordinated indicators to embed collaboration within the post-2015 development goals. Both NTD and WASH actors seek to promote shared values of equity and inclusion, and both aim to serve the poorest and most marginalised communities. Collaboration between NTD and WASH actors can increase the effectiveness of programmes towards their individual and common goals.