Providing access to water, sanitation and hygiene or WASH to everyone has been the focus of governments for many decades. The declaration of the Millennium Development Goals (MDGs) in 2000 set aside definite targets for water and sanitation that countries need to work towards. While there has been substantial improvement in increasing access to drinking water and sanitation, more than 663 million people lack access to safe water and 2.4 billion people (predominantly in sub-Saharan Africa and southern Asia) lack access to improved sanitation facilities (WHO and UNICEF, 2015).

India has met the water target but has made only moderate progress towards achievement of the sanitation target with 52.1 percent of rural and 7.5 percent of the urban population still practising open defecation (NSSO, 2016). The progress made towards the MDGs has not been uniform and has often excluded the marginalised and the poorest of the poor.

A study in Odisha by Sahoo et al. (2015) revealed that women face several psychological, social and health stresses while accessing sanitation facilities across their life course in three different geographical settings--urban slum, rural village and tribal village. Further, a study by Jones (2013) in Rajasthan stated that the distance travelled by elderly persons to defecate in private can often be up to 2km from their houses. These facts suggest that the paradigm for identifying beneficiaries and understanding their needs and requirements for delivery of WASH services requires a revisit.

With time, WASH policies and implementation seem to have moved from the overarching objective of provision of universal access to the identification of geographic, income and caste-based categories such as rural, urban and poor as vulnerable population groups. This categorisation, however, does not shed light on the nuanced needs and requirements of human beings across their lifespan. The life-cycle approach is one of the approaches that can be used to understand these needs and how different population segments access WASH facilities.

The idea behind this approach is that humans have different phases in their life course such as infancy, childhood, adolescence, adulthood, old age and disabilities through which their requirements change. By understanding the requirements for each stage, WASH policies and programmes can be tailor-made to ensure equitable access. While this approach is fairly new in the WASH sector, it has been employed to great effect in disciplines such as health, social work and psychiatry.

The life-cycle approach in practice

IIT Madras undertook a study to understand the extent to which the WASH sector incorporated the life-cycle approach into policy, programmes and projects during the MDG period of 2000–2015. This was a multi-country systematic review which included 11 countries from South Asia (India, Bangladesh, Nepal, Pakistan) and sub-Saharan Africa (Ethiopia, Kenya, Nigeria, Malawi, Madagascar, Tanzania, Uganda). A systematic review is one of the popular tools for evidence-based policy making which employs explicit and transparent methods to find as much research relevant to the research question.

The study was a portfolio review which analysed WASH policies, programmes and projects (herein referred to as projects) of governments, multilateral and bilateral agencies and international NGOs. Qualitative comparative analysis (QCA) was the primary research tool used for this review and was supplemented by descriptive statistics. A methodical process was followed to identify population segments, policy and project documents. This systematic process involved, for instance, use of an explicit search strategy and inclusion/exclusion criteria to identify documents. A coding tool and a set of indicators were also developed to help in extracting and coding data from documents which included the identification of:

• barriers faced in accessing facilities such as adequacy and attitudinal constraints
• strategies that were proposed or used to address WASH problems such as beneficiary participation and decentralisation of service delivery
• benefits that lead to actual improvement in access such as improving availability, ensuring it is physically accessible and affordable

Categorisation of population segments based on the human life-cycle was also done by identifying the different life stages and subsequently grouping them based on age, sex, disabilities and people with HIV/AIDS (PLHIV). These life-cycle segments included children, adolescent girls and boys, women, men, transgender, senior citizens, disabled and PLHIV. Population segments were also categorised based on geographic location, income and social status such as rural, urban, poor, caste, ethnicity, migrants and pastoralists and vulnerable by occupation. These segments were called geographic and social segments.

Findings from WASH policies

The data consisted 59 policies of which 46 were from Asia and 13 were from Africa. Policies from Asia included state policies as well from India and Pakistan. Among the 46 Asian policies, 27 were from India and this number included 22 state policies and five national policies.

Life cycle vs geographic and social segments in WASH policies

In almost all the documents, target population segments were mentioned based on life cycle and geographic and social categories. On an average, WASH policies from Asia and Africa mentioned an average of three life-cycle, geographic and social segments. However, it was found that there were more evidences for the latter. There was also a lot of emphasis on universal access and some Asian policies focused primarily on this concept without mentioning specific population segments. This trend was noticed in Indian policies as well. In fact, Nepal and Bangladesh had wider representation of life-cycle segments than India.

In Africa, all WASH policies mentioned at least one life-cycle segment. The emphasis on universal access and geographic and social segments could be a reflection of the objective of the policy to ensure that each and every person has access to WASH facilities and/or a policy focus on improving institutional capacity and service delivery as a result of which life-cycle segments had limited mention.

Among the life-cycle segments, women and children were targeted the most in Asian and African policies while other segments such as senior citizens, men, adolescents and the disabled were not given much attention as shown in figure 1. People with HIV/AIDS were targeted more in Africa reflecting the demographic trends in the region while the lack of attention to the transgender community in WASH policies in both Asia and Africa was conspicuous.

Barriers: The policies discussed several constraints that hinder access to WASH facilities although to a limited extent. It was found that these constraints (which the study categorised as barriers) predominantly related to environmental constraints which include limitations based on geographical location, distance and time to access WASH services and facilities in Asia (including India) and Africa. Women, children and adolescent girls seemed to be the most affected as they often have to walk long distances to fetch water or to defecate.

Strategies: WASH policies also described several ways of addressing the WASH needs of the population. Categorised as strategies, these were related to beneficiary participation, project management and information, education and communication (IEC).

It was also found that beneficiary participation, referring to the involvement of end users in planning, implementation and maintenance of WASH facilities, was the most discussed strategy for life-cycle segments. Project management strategies such as “Panchayati Raj institutions should be supported to manage their drinking water sources” (India’s Strategic Plan for Water, 2011) and “provide research and training to institutions to address issues, build skilled manpower and develop technology” (India’s National Water Policy, 2012) were discussed most for geographic and social segments.

Benefits: Ensuring the availability of WASH facilities was the most identified benefit in WASH policies for both life-cycle and geographic and social segments in Asia and Africa. This emphasis on ensuring that the facility is available for beneficiaries reflects the fact that improving availability continues to be a challenge and priority of governments. It also aligns with the goals of the MDGs which stressed on the provision of improved water that was free from contamination and improved sanitation facility that hygienically separates human excreta from human contact.

Findings from WASH projects

The data set for the review comprised 131 project documents: 59 from Asia, 72 from Africa and 25 projects pertaining to India.

Life cycle vs geographic and social segments in WASH projects

Findings from projects were similar to policies in that geographic and social segments received more coverage than life-cycle segments. However, unlike WASH policies which mentioned an average of three life-cycle and geographic and social segments, projects mentioned an average of two segments. Further, among the life-cycle segments, women and children were discussed in more than 50 percent of projects while all the other life-cycle segments were mentioned in less than 35 percent of projects.

In India, there seems to be an overwhelming emphasis on women with 83 percent of projects targeting them. The emphasis on women perhaps reflects the historical emphasis given to this segment at a global level such as the United Nations Water Conference at Mar del Plata, 1977, the International Drinking Water and Sanitation Decade (1981-90) and the International Conference on Water and the Environment in Dublin (January 1992), which explicitly recognised the central role of women in the provision, management and safeguarding of water.

Barriers: Descriptions of barriers that were identified in project documents were limited. Projects primarily discussed constraints related to inadequacy of WASH facilities for both categories of segments with statements such as “existing water supply schemes connect only limited population groups and women and children are forced to collect water from public stand posts” (Punjab Rural Water Supply and Sanitation Sector Improvement Project, India, 2015).

Strategies: Information, education and communication (IEC) was the predominantly identified strategy in WASH projects, reflecting low level of awareness among beneficiaries in Asia and Africa. In fact IEC was the preferred strategy in most projects and was often used in combination with other strategies such as promoting demand for WASH facilities, encouraging beneficiary participation and decentralisation. Some examples of IEC strategies include, “hand washing sessions to be conducted before mid-day meals to deliver hygiene message and messages on sanitation, drinking water safety for children” (Swachh Bharat Swachh Vidyalaya, India, 2014).

Benefits: Reflecting the trend in WASH policies, availability of WASH facilities was the most common benefit identified across both categories of segments, as seen in figure 2. However, there was a distinction between the other types of benefits identified for life-cycle and geographic and social segments. Physical accessibility that included the construction of disabled and child-friendly toilets was the commonly mentioned strategy for the former. While, there seemed to be a greater focus on affordability for the latter with statements such as “provide financial incentives or incentives in the form of construction material for BPL households to construct latrines” (Swachh Bharat Gramin, India, 2014).

The way forward

Descriptions of results for policy as well as project documents show that there continues to be an overwhelming emphasis on a geographic and income-based categorisation of beneficiaries to provide WASH services. This emphasis is understandable especially in India given the geographical diversity in the socio-economic dimension including the extent of poverty across geographical regions.

However, it is important that population segments categorised by the human life-cycle also find equal place in the WASH narrative. Even among the life-cycle categorisation, the focus has been predominantly on women, children and adolescent girls.

While it is important to focus on these vulnerable segments, all segments within the life cycle should be given equal importance. In this context, life-cycle segments could also be considered a sub-category of geographic and income-based categorisations and policy makers and practitioners should take systematic steps to incorporate life-cycle elements in policies and projects.

Akshaya Ayyangar is project associate at the Indian Institute of Technology Madras. Email at: akshaya.ayyangar@gmail.com

For queries about this research, please contact: Evidence_research@wmail.iitm.ac.in