Equity, WASH and Covid-19 intersections

As the COVID-19 pandemic continues to unfold, governments are focussed on hospital and intensive care unit (ICU) capacity and securing enough PPE for their health workers. In the emergency stages of response the focus on clinical and health sector responses dominated preventative measures. This prompted water, sanitation and hygiene (WASH) focussed multilateral platforms such as Sanitation and Water for All (SWA) and UNICEF to lobby for a great focus on WASH as the first line of defence for this and future epidemics. SWA’s Call to Action highlights that WASH should be available to everyone, and, in line with the Sustainable Development Goals, eliminate inequalities and leave no-one behind.

Of all the elements of WASH, handwashing with soap is a particularly critical one. SARS-CoV-2 is a virus with a lipid layer broken down by soap, and so washing hands with soap has never been more important for preventative health. Changing human behaviours is notoriously difficult: shifting hygiene and handwashing behaviours has been one of the toughest nuts to crack in WASH, and equally hard to measure. As videos of handwashing with soap (HWWS) go viral in social media and signs are plastered in public places more than ever, are we witnessing a renaissance for handwashing? If we are, it will have benefits for not only preventing the spread of covid-19 but also other water-borne diseases with high morbidity and mortality rates like diarrhoea.

Yet so many communities lack the facilities to enact this barrier of defence, as currently highlighted by the WHO/UNICEF Joint Monitoring Program. Globally 1 in 3 people do not have basic handwashing facilities at home (WSSCC), the bulk of them in lower and middle income countries.  The situation in healthcare facilities is particularly alarming: 1 in 4 have no clean water on site; and 1 in 5 have no decent toilets (WaterAid). Of Australia’s nearest neighbours Timor Leste, only 28% of households have access to basic handwashing facilities (with water and soap). In Indonesia, 38% of the rural population (45 million) and 22% of the urban population (31 million) have no handwashing facility at all in their household (JMP 2017). Indonesia has registered 22,000 cases as of May but health specialists suggest this is probably an underestimate due to low levels of testing. In many instances even if households want to increase handwashing they are constrained by inequitable water access.

In the five months since covid-19 started it has spread to more than 180 countries and 5 million people in that short space of time. From where I sit (at home in Australia), the data being presented in global press overwhelmingly emphasises the case loads of developed or middle income countries (e.g. US, Russia, South Korea, Italy, Brazil). Cases reported in countries with less robust healthcare and monitoring systems are less represented. Is this because they have fewer cases, or are less able to accurately measure them? It may be years before we know the answer to this, and this itself represents the possible inequitable toll the virus may take.

The impacts of the COVID-19 pandemic on equity will take time to be revealed. In Australia, restrictions are having gendered impacts in essential services on women who are over-represented as nurses, carers and teachers, in access to paid work where more women have left employment due to economic downturn, and in the household where studies are showing women have taken on more of the domestic load. In contexts where access to WASH services is already challenging there are already well documented gender and social inclusion issues. How are covid-19 risks and restrictions altering or exacerbating existing inequalities in accessing WASH? What about in densely populated areas or in water scarce or flood-prone areas? WASH professionals need to consider intra- and inter-household equity issues within a do-no-harm framework.

Covid-19 is highlighting inequalities within households and societies and between countries. There is no doubt that WASH is a first line of defence against this pandemic and there cannot be adequate responses without adequate WASH. We must understand the complexities and nuances of delivering adequate WASH as we continue to work towards improving these services and decreasing inequalities as we do so.

The blog author, Bronwyn Powell is also a Water and WASH Specialist with over 20 years’ experience in the Asia-Pacific.  

Inadequate water, sanitation and hygiene (WASH) services impact on the health, livelihoods and wellbeing of many families around the world. Learn more in our Introduction to WASH Development Online Training Program. Details here. 

Read more about IWC’s work in addressing social and gender inclusion issues in Fiji and Indonesia via the Australia government supported grant Engaging corporate actors for inclusive WASH-at-work linked to the Water for Women Fund.

Banner image courtesy of Clear Water.