Water, Sanitation and Hygiene (WASH)

The United Nations General Assembly explicitly recognised access to safe drinking water and sanitation as a human right, and acknowledged the essential nature of water and sanitation to the realisation of all human rights in 2010. However in many contexts persons with disabilities are excluded from accessing water, sanitation and hygiene (WASH) services for reasons including poor or distant placement of WASH infrastructure, inaccessible toilets and water supplies, exclusion from community hygiene awareness and general WASH planning processes, and stigma and discrimination.

Persons with disabilities may have greater water requirements than some other community members – for instance, if they use their hands for mobility or for balance while going to the toilet, they will have increased washing needs. It is vital that their needs are specifically considered in all aspects of WASH programming.

Inclusion of persons with disabilities in WASH programs typically requires only minor modifications, and when built into program design represents minimal additional cost. Improved accessibility of WASH infrastructure also benefits other members of the community, such as children, frail older people, pregnant women, and people who are ill or temporarily injured.

When persons with disabilities are included in WASH programs they may experience greater dignity and self-reliance, improvements in health and nutrition, and greater access to education if school WASH facilities are accessible. WASH-related caregiving duties that are usually borne by women and girls, such as fetching water, may be reduced for family members of persons with disabilities. Inclusion in WASH community processes and provision may also increase the visibility and self confidence of persons with disabilities, and enhance their inclusion and participation in other aspects of community life.

The available resources are mainly designed for WASH practitioners. Many focus on accessible infrastructure, and are useful for this aspect of WASH. However, it is also necessary to consider inclusion throughout the whole program management cycle, and to ensure community education and decision-making processes are also inclusive.

See also: Accessible infrastructure and communications

UNICEF (2018) The Case for Investment in Accessible and Inclusive WASH

This technical paper highlights evidence to argue that accessible and inclusive WASH is achievable at low cost, by using universal design, community-driven change, and existing knowledge, expertise and methods. The paper provides starting points to understand the impact of and case for accessible and inclusive WASH.

UNICEF (2021) MAKE IT COUNT: Guidance on Disability Inclusive WASH Programme Data Collection, Monitoring and Reporting

This guidance contains approaches and tips to collect disability data that can identify persons with disabilities and define their barriers to WASH, and monitor and report the results and impact of WASH programmes for persons with disabilities. The guidance is available in English, French, Spanish and Arabic, and accessible formats including ePub, DAISY and Braille-ready.

Water for Women (2021) Disability-inclusive WASH: Practice within Water for Women

This learning brief explores key lessons learnt from implementing disability-inclusive WASH projects and research across Water for Women – in particular, strategies that contribute to meaningful participation and equality of outcomes. The paper consolidates learnings around what it takes to engage meaningfully with people with disabilities in their full range of diversity and highlights how more marginalised people with disabilities can be successfully reached.

Water for Women (2022) Partnerships for Transformation: Guidance for WASH and Rights Holder Organisations

This guidance provides practical recommendations for effective collaboration in all types of partnerships. It shares experiences of the drivers, benefits and challenges of partnerships, as well as useful case studies and links to further resources. It particularly looks at WASH partnerships involving women’s organisations, OPDs and SGM organisations; a focus of Water for Women. It is designed to support organisations looking to begin, build or strengthen partnerships as a way to achieve mutually beneficial outcomes, especially in terms of making WASH programs more sustainable, inclusive and supportive of gender and social norms transformation in WASH systems, and society at large.

Water for Women (2022) Shifting Social Norms for Transformative WASH: Guidance for WASH Actors

This guidance note refers to social norm change in, and through, WASH programs. The checklists provide guiding questions and practical examples that can be used to increase understanding of how to implement a social norms initiative as a component of WASH programs. This guidance primarily draws from the literature on shifting social norms that sustain gender-related harmful and exclusionary practices; there is less documented experience on shifting social norms that perpetuate the exclusion of people with disabilities and people with diverse gender identities and sexual orientations. Examples from projects supported by Water for Women in Timor-Leste, Papua New Guinea, Solomon Islands, Indonesia, Nepal, Bhutan and Vanuatu are presented. They describe interventions that employ different approaches to engaging on social norms and the projects’ successes and challenges.

Megaw,T, Gero,A & Kohlitz, J (2022) “Nothing about us, without us!”: Disability inclusion in community-based climate resilient programs. A case study of Indonesia

This article seeks to assess how climate change affects water, sanitation and hygiene (WASH) services, and gender and social inclusion outcomes. In the design of climate-resilient programs for community development, there is growing awareness of the benefits of gender assessments, but it is far less common that disability is considered. The meaningful inclusion of people with disabilities can reveal their knowledge and capacities to contribute, and result in more contextualised and socially-just responses to climate change and WASH services.

UNICEF (2021) Menstrual Health & Hygiene for Girls and Women with Disabilities

Menstruation is a natural fact of life and a monthly occurrence for 1.8 billion girls and women of reproductive age. Yet millions of menstruators across the world are denied the right to manage their monthly menstrual cycle in a dignified, healthy way. Girls and women with disabilities face even greater challenges in managing their menstruation hygienically and with dignity, often facing a double stigma due to both social norms around gender and menstruation and having a disability. This tip sheet offers a framework for supporting menstrual health and hygiene (MHH) and practical entry points for meeting the needs of menstruators with disabilities

World Vision Vanuatu & London School of Hygiene & Tropical Medicine (2020) Water, Women and Disability study in Vanuatu

This Water, Women and Disability study, the baseline study for the Laetem Dak Kona (LDK) Project, aimed to complete a comprehensive mixed-method (qualitative and quantitative) population-based study of disability in TORBA and SANMA Provinces, to measure how common disability is, and understand access to, and experience of WASH, menstrual hygiene management and incontinence amongst persons with and without disabilities with a gender lens.

Coultas, M. and Iyer, R. with Myers, J. (2020) Handwashing Compendium for Low Resource Settings: A Living Document

This compendium from the Sanitation Learning Hub at the Institute of Development Studies aims to inform the design of handwashing facilities and hygiene promotion activities, particularly in response to the COVID-19 pandemic. It provides guidance on and local examples of low-cost handwashing facilities, environmental cues and physically distanced hygiene promotion, with a focus on ensuring accessibility for people with disability and other user groups. It should be read in conjunction with other guidance and standards relating to accessible water, sanitation and hygiene facilities.

WaterAid Gender Equality and Disability Inclusion within water, sanitation and hygiene

The paper is intended as a conversation starter for WASH program managers and other development practitioners looking to strengthen their conceptual and practical understanding of challenges and successes in integrating gender and disability in WASH; and those looking to move towards more transformative and sustainable practice. Preliminary recommendations are provided; however, this is not intended to be a comprehensive practice note.

CBM Australia 2016-2019 Guidance on disability inclusive WASH from CBM Australia

CBM Australia works with partners, including aid donors, NGOs, government agencies and disability organisations, providing advice on how to ensure that water, sanitation and hygiene programs are accessible to people with disability. At the link www.cbm.org.au/our-resources/wash you will find guidance notes, training toolkits, case studies, and learning about appropriate approaches for ensuring that people with disability can access WASH in resource-poor settings.

Human Rights Watch (2017) Going to the Toilet When You Want: Sanitation as a Human Right

This report provides powerful evidence of how denying access to sanitation is a human rights violation. It investigates provision of sanitation in facilities such as schools, prisons, health facilities, residential facilities for people with disabilities, and workplaces. While not focused solely on people with disabilities, the report provides a wide range of examples which highlight the additional discrimination faced by people with disabilities (and particularly women and girls with disabilities) accessing sanitation in a range of settings. It would be useful to provide evidence for use in advocacy on the rights of people with disabilities to access sanitation and how a lack of accessible sanitation can restrict participation in society.

White S, Kuper H, Itimu-Phiri A, Holm R and Biran A (2016) A qualitative study of barriers to accessing water, sanitation and hygiene for disabled people in Malawi

This research study explored the WASH priorities of persons with disabilities in Malawi and the barriers faced in accessing WASH. No two individuals reported the same set of barriers which highlights the importance of listening to people with disabilities and including them in WASH planning processes. While other WASH publications have focused primarily on barriers in accessing WASH for persons with disabilities, this study also looked at WASH needs associated with disability and the consequences of not having these met. It found that persons with disabilities and caregivers may have different or greater WASH needs (e.g. additional bathing requirements as a result of incontinence). Not having these met was seen to result in poorer health, stigma and reduced self esteem. This report is useful background reading for WASH Program managers to understand the range of challenges persons with disabilities face in accessing WASH and the importance of disability inclusive practices.

WaterAid and Water, Engineering and Development Centre (WEDC) Inclusive WASH: what does it look like?

This one page checklist gives a benchmark of an inclusive WASH program at a community level, including inclusive processes, designs, communication, monitoring and evaluation as well as accessible infrastructure. It may be useful to inform the monitoring and evaluation frameworks of larger WASH programs that include community initiatives.

WaterAid (2011) What the Global Report on Disability means for the WASH sector

This briefing paper highlights the main findings of the World report on disability and how they relate to the WASH sector, including barriers and enablers for inclusive WASH. It also applies the main World report recommendations to WASH programming, with specific examples of projects focusing on accessible infrastructure. The briefing provides some guidance on the development of national accessibility standards in relation to WASH.

Humanity & Inclusion Source: Key list resources on inclusive WASH and disability

Handicap International, is a comprehensive and frequently updated online resource centre on disability inclusion. Its key list on WASH includes a number of resources, mostly providing practical guidance to support implementers of WASH programs. The list was compiled by WaterAid and the Water, Engineering and Development Centre (WEDC) in the UK.

CBM Australia (2012) Inclusion made easy: A quick program guide to disability in development – WASH Chapter (in Part B)

This practice guide provides broad programming guidance for disability inclusive WASH using a twin track approach. It also includes case studies and checklists. It has been designed for implementing WASH partners, particularly program managers/officers. It is also useful for organisations involved in program review and interactions with implementing partners.

Jones H and Reed B (2005) Water and sanitation for disabled people and other vulnerable groups: designing services to improve accessibility

This online book is a useful resource for program planners and service providers who require detailed guidance on accessible design and practical WASH infrastructure solutions at a household level. It gives background on disability and WASH and details approaches to accessibility, for various impairment groups. It also includes detailed case studies from several countries of specific types of technology for making household WASH facilities accessible. It is useful for those wishing to gain an understanding of the breadth of accessible WASH infrastructure.

WEDC (2011) Inclusive design of school latrines: How much does it cost and who benefits?

This briefing note covers the main issues for inclusive sanitation in educational settings, provides indicative costings and includes design and construction recommendations.

Gosling L (2010) Equity and inclusion: A rights-based approach

This report outlines WaterAid’s approach to equity and inclusion (including disability inclusion). While the report considers specific organisational actions and implications that are not relevant to those outside WaterAid, it also describes a useful conceptual framework for understanding equity and inclusion in WASH more broadly, and thinking beyond accessible infrastructure.

WaterAid Inclusive WASH website

This website is hosted by WaterAid with contributions from a range of organisations. It is an online learning portal for WASH practitioners. It includes an extensive resource guide, forums, case studies, webinars and training materials regarding the inclusion of persons with disabilities, as well as the poorest of the poor, people living with HIV/AIDS or chronic illness, and women and girls. It is regularly updated. Whilst aimed at practitioners, the site provides helpful examples and practice notes that can be used to inform policy and larger programs.

This is a case study on Indonesia’s Community-Based Drinking Water and Sanitation Program (PAMSIMAS) which included disability-inclusive approaches in its components. The first section of this case study discusses why and how, with the Assistance of the Government of Australia (GoA), this project has been able to involve persons with disabilities through all stages of the process. The second section analyses the cost of disability-inclusive activities in both the soft and hard components of the WASH program.

This page contains a number of implementer level case studies of inclusive WASH, which are helpful for understanding what disability inclusive WASH can look like at a community level.

There are no video link available

Picture of a woman in Bangladesh who is a wheelchair user at an accessible water pump. The water pump is low enough to be reached sitting down, and has a long handle which she is using to collect water in a plastic bucket underneath.

Photo: Wahid Adnan, Drik 2012

Kazol (23, Bangladesh) fetches water from a wheelchair accessible pump. To read Kazol’s full story click here. Copyright: Centre for Disability in Development/CBM Australia