Volunteers in Kenya have initiated a campaign to raise awareness about safe health and hygiene practices during the global pandemic. The @SowetoYouthInitiative displayed #SolidarityInAction by going door to door delivering soap to families and setting up community hand washing stations
Volunteers in Kenya have initiated a campaign to raise awareness about safe health and hygiene practices during the global pandemic. Photo: SDG Action Campaign, Flickr Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)

What determines if you have enough water nearby for washing your hands in the middle of a disease outbreak? There are many inequalities in access to water, sanitation and hygiene services (known together as WASH), which result from factors like where you live and work and your socio-economic status. And these inequalities are important drivers of vulnerability to COVID-19 because water, sanitation, and hygiene services are closely linked to controlling the spread of the virus. However, these inequalities are not systematically evaluated or monitored, and this lack of knowledge is a barrier to effective responses to the pandemic.

Furthermore, COVID-19 creates even more problems in obtaining safe access to WASH services. About three billion people lack basic hand-washing facilities in their homes. How can peope comply with a lockdown or curfew and follow hygiene recommendations if they don’t have safe drinking water or sanitation facilities in their homes?

So far during the pandemic the WASH sector has focused on removing barriers to access to safe water and sanitation sites, for example Sao Paolo suspended water tariffs for low-income families for 90 days. However, through measures like waiving bills and guaranteeing continued service provision, this effort has primarily focused on those who already have access to services. While interventions have in some places set up new hand-washing stations, for example as WaterAid has done in Bangladesh, India, Nepal and Ethiopia, as well as providing soap and disinfectant and raising awareness about hand hygiene, the fact remains that many still lack access to safe water and sanitation in or near their homes, making basic COVID-19 mitigation guidelines almost impossible to follow.

Inequalities linked to WASH are driving vulnerability to the pandemic

While WASH services are talked about as a key line of defence in fighting COVID-19, the pandemic is in many ways exacerbating inequalities related to WASH. Recommendations to control the pandemic centre around the importance of social distancing and hand-washing, but without adequate water and hand-washing services in the household many people need to use shared or communal facilities where social distancing can be difficult and hygiene conditions poor. In many cases, shared facilities are not available at all.

These challenges risk reinforcing gender and other social inequalities. Many national response plans have led to regression in gender norms. Lockdown has contributed to soaring domestic violence rates, and school closures have added to women’s already disproportionate care burden. Because of this, and a lack of safe and accessible hand-washing services, women and girls globally have been put at even higher risk of infection. Other marginalized groups are also at greater risk of infection, violence and discrimination. The elderly, the sick, and people with disabilities face mobility challenges that prevent them from accessing WASH facilities outside their homes. Those living in chronic poverty, refugee camps, informal settlements, or prisons are unable to socially distance. Moreover, the experience of WASH scarcity amplifies psychosocial distress, further worsening inequalities during the pandemic.

Ways forward

Improving the coping capacity of those with shared or communal WASH services, of those without services, or of people with difficulties in reaching or using them, has proven difficult. For COVID-19 responses to efficiently target the most vulnerable, practitioners urgently need to better understand how and when WASH interventions work and for whom, by ensuring reliable evidence is collected. We need to understand which interventions can be adapted to be delivered under curfew, lockdown or when social distancing, and which are the most effective under those conditions. To prevent the humanitarian impact from deepening, we also need to better understand what support communities need to themselves improve their water access and sanitation services, such as funding and information about safe practices. Not only is this research vital for at-risk communities, it also aligns with the UN’s commitment to the localization of aid – that is, to make “humanitarian action as local as possible and as international as necessary”.

SEI project sets out to advance understanding

In line with the UK’s Foreign, Commonwealth & Development Office’s (FCDO) COVID-19 response agenda, within the project Gender and Social Equality in WASH, funded by the Centre of Excellence for Development, Impact and Learning (CEDIL), SEI is using systematic review methodology to synthesize evidence on the gender and social equality outcomes of WASH interventions in low- and middle-income countries. By evaluating a range of gender and social equality outcomes, the project will enable practitioners to address vulnerabilities and “building forward better”. SEI will also provide methodological advice on how to include and assess gender and social equality in WASH programmes. The aim is that the synthesis of scientific research will support the design and implementation of gender and social equality mainstreaming in WASH and provide lessons from best practice. The first findings of the project are expected in autumn 2021.