Water, sanitation and hygiene (WASH): the evolution of a global health and development sector
Despite some progress, universal access to safe water, sanitation and hygiene (WASH) by 2030—a remit of Sustainable Development Goal 6—remains a distant prospect in many countries. Policy-makers and implementers of the WASH sector are challenged to track a new path. This research aimed to identify core orienting themes of the sector, as legacies of past processes, which can provide insights for its future. The authors reviewed global policy, science and programmatic documents and carried out 19 expert interviews to track the evolution of the global WASH sector over seven decades. The authors situated this evolution in relation to wider trends in global health and development over the same time period.
With transnational flows of concern, expertise and resources from high-income to lower-income countries, the WASH sector evolved over decades of international institutionalisation of health and development with (1) a focus on technologies (technicalisation), (2) a search for generalised solutions (universalisation), (3) attempts to make recipients responsible for environmental health (responsibilisation) and (4) the shaping of programmes around quantifiable outcomes (metricisation). The emergent commitment of the WASH sector to these core themes reflects a pragmatic response in health and development to depoliticise poverty and social inequalities in order to enable action. This leads to questions about what potential solutions have been obscured, a recognition which might be understood as ‘uncomfortable knowledge’—the knowns that have had to be unknown, which resonate with concerns about deep inequalities, shrinking budgets and the gap between what could and has been achieved.
This article appeared in the BMJ Global Health. Read the full article here.
Author(s) / editor(s)
Sara de Wit et al.
About the author(s) / editor(s)
S. De Wit, E. Luseka, D. Bradley, J. Brown, K. Bhagwan, B. Ewans, M.C. Freeman, G. Howard, I. Ray, I. Ross, S. Simiyu, O. Cumming, C.I.R. Chandler
Sara de Wit is assitant professor at the University of Leiden, is trained in cultural anthropology and African Studies and has long-term fieldwork experience in southeast Madagascar, the Bamenda Grassfields in Cameroon and Maasailand in northern Tanzania. By carrying out multi-sited ethnographic research, she has explored how globally circulating development ideas and technologies – such as climate change and weather forecasts - ‘travel’ to different African contexts, and what happens when different worlds of knowledge and expertise meet. She studied these broad themes at the intersection of environmental anthropology, history and Science and Technology Studies (STS).
For her PhD research (University of Cologne), she has carried out fieldwork among the semi-nomadic Maasai in northern Tanzania to explore how they make sense of climate change and this new discourse. In 2017, Sara joined the Institute of Science, Innovation and Society (InSIS, University of Oxford) as a postdoctoral research fellow. She has been part of the Forecasts for Anticipatory Humanitarian Action (FATHUM) project, in which she explored how climate scientists and humanitarians construct and negotiate ideas of success of humanitarian anticipation ahead of disasters (Mozambique, Uganda and South Africa). Her work has been used by the Red Cross Society and The United Nations Office for the Coordination of Humanitarian Affairs (UN OCHA). Furthermore, Sara has carried out a history of the Water, Sanitation and Hygiene sector (WASH), for the London School of Hygiene and Tropical Medicine, which has informed the Lancet Commission on WASH.
In 2023, together with two other newly appointed Assistant Professors, Miriam Waltz and Sheila Varadan, Sara has launched the LUNHA Hub (Leiden University Network for Health in Africa). LUNHA wants to create a broader space for social sciences and humanities in discussions about global health in Africa. By collaborating with various partners, including civil society, policymakers, and academia in Africa, LUNHA seeks to lead critical discussions and change the direction of global health research beyond biomedical epistemologies, towards more inclusive approaches that include planetary health and issues of justice and
Posted on 8 January 2025, last modified on 8 January 2025