In this section, we discuss three factors that influence whether WASH practices are adopted in a community: economic factors; gender and privacy issues; and caring for the environment.
Economic factors influence WASH practices
The cost of constructing a protected water source, a latrine or handwashing facilities may be too much for some households to pay, especially when purchasing WASH facilities and services is seen as a lower priority than spending limited financial resources on other needs. Primary priorities for most households, whether urban or rural, include secure housing, food, clothing and education for their children, and possibly also transport costs to take children to school or adults to work. Installing even the most basic latrine or handwashing basin may be unaffordable, but people can still wash their hands with a bowl and a bar of soap (Figure 13.7).
However, constructing a latrine is much more expensive than buying a plastic bucket and some soap.
Local government may be able to assist households to obtain loans at low interest rates so that they can install WASH facilities. Community WASH projects may also be funded by local contributions and provide shared labour to build a communal latrine or protect a water source from contamination by human and animal waste.
Although there are costs involved, installing a WASH facility can also save some expenses for a household that uses them consistently. Diarrhoea, worm infestations and other communicable diseases resulting from poor WASH practices cause a significant economic burden on individuals, families, and communities.
Can you think of expenses that the family of a child with severe diarrhoea will have to pay?
You may have mentioned the cost of treatment, including transport costs if the child goes to the health centre; and family members may lose income from their employment while caring for the sick child.
These expenses could have been reduced by using a latrine, handwashing at critical times and accessing improved water sources. The prevalence of diarrhoea among children in low-income countries is still high: it tops the list of causes of morbidity (illness) in children under 5 and accounts. If you multiply the costs to a single family with a sick child by the huge number of illness episodes that could be prevented by good WASH practices, you can see that WASH could bring huge economic benefits to the nation.
Gender, privacy and access issues influence WASH practices
It is against many cultures for women and girls to urinate in public, but it is quite common to see men and boys urinating in the street. Access to a safe and private place for this purpose is, therefore, a high priority for women, who may suffer great discomfort to avoid urinating or defecating until night time when they can go without being seen. However, this also exposes them to the risk of rape or robbery. Therefore, the provision of household latrines is a gender issue: it affects males and females differently.
Another difference between the genders in most families in low-income countries is that a woman prepares all the food. If her hands are clean when she touches food items and she washes fruits, vegetables and cooking utensils in clean water, the risk of transmitting infectious organisms to family members is much reduced. Research has shown that washing the hands with soap at critical times can reduce the incidence of diarrhoeal diseases in families by as much as 44%, and even without soap the reduction is about 30% (Curtis et al., 2011). This is very important in places where traditional food is eaten with the hands (Figure 13.8).
Installing handwashing facilities or building a latrine for the household therefore brings benefits to women in particular, but also improves the health of all family members.
Caring for the physical environment improves health outcomes
In Study Session 8, you learned about pollution of the urban environment when human excreta, household waste, animal droppings and other filth collects in the streets. All waste products are sources of disease because they attract rats, mice, dogs, flies and mosquitoes that can transmit infectious organisms to people. Bacteria, viruses and worms in rotting food and faeces are washed by rain into the soil and local sources of drinking water; they contaminate crops and get onto the hands of people working on the land or children playing. Unless hands are washed at critical times, the transmission of infection from soil to hands and into mouths is impossible to prevent. Therefore, keeping the community environment clean and free from waste (Figure 13.9), and persuading people of the health benefits of handwashing and latrine use are key goals for health workers and WASH workers.