What I’ve learned in 10 years of working to make water, sanitation and hygiene inclusive

6 min read
Jotti, 12, who has a rare physical disability, walks down the ramp from her family's customised disability-friendly toilet in Khulna, Bangladesh. 24 August 2020.
Image: WaterAid/ DRIK/ Habibul Haque

Are we doing enough to make water, sanitation and hygiene services as inclusive as possible? Louisa Gosling shares her reflections on how far we have come, and what else we need to achieve.

I started working on equality, inclusion and rights in the water, sanitation and hygiene (WASH) sector in 2011. The challenge then, as it is now, was to do three things:

  • To raise awareness of inequalities and exclusion by encouraging people working on WASH to think about the different needs of different people and understand the barriers they face.
  • To develop the skills and confidence of WASH professionals.
  • To get WASH professionals to recognise the limits of their expertise so that they reach out to others who can help find solutions.

So, in the past 10 years, what have I learnt about getting WASH professionals to think about diversity? How do you get a highly educated, confident and usually male expert to understand the experience of a girl who uses crutches and needs access to a clean and safe school toilet to manage her periods? How do you get these experts, who are used to being listened to, to imagine what it’s like for a woman on a water committee, listening to men make decisions about the provision of water and sanitation in her village? And then, most importantly, how do you get these WASH experts to act on such insights?

The women's group holding a meeting, in the village of Samabogo, in the Circle of Bla, Region of Segou, Mali, May 2017
The women's group holding a meeting in the village of Samabogo, Circle of Bla, Segou, Mali, May 2017
Image: WaterAid/Basile Ouedraogo

At the start, we tried to find training exercises that would open people’s eyes. One of the simplest and most illuminating is the Squatting Exercise. Take a large sheet of paper and draw a small circle on it to represent a toilet slab. Next, ask different people to try squatting over the circle. One person might wear a heavy rucksack over their front to represent the experience of being pregnant. Another might tie a splint to their leg so they can’t bend it. People will usually lose their balance and put a hand on the floor. Ask another to wear a blindfold and find the right place to squat. They usually put a foot in the toilet.

Everyone laughs, but people who've done this exercise remember it for a long time. They remember how disgusting it felt to put their hand on the floor to keep their balance – even in their imagination. They realise how simple design changes can make a massive difference – providing more space in the cubicle, adding strong handrails in the right places, and doors that open and close easily.

Another great exercise is the accessibility and safety audit – a simple checklist that makes you pay close attention to how toilets or water points are accessed and used. In Tanzania, a couple of years ago, we asked some people waiting at a rural health centre to advise us, and an older woman offered her expertise. She was petite, used a stick to help her walk and had limited vision. My colleagues and I walked with her from the health centre to the patients’ toilets, and she pointed out the many obstacles on the way – bits of rubbish, sticks, some discarded bricks – all of which made the journey more difficult. The location of the toilet did not feel safe to her either. It was out of sight of the health centre, and she found it difficult to step up into the cubicle. She showed us how different the experience would be if there were shallower steps or a ramp with a handrail to hold onto. She pointed out critical features that we would not have noticed without her.

Over the past decade, we have also learnt how to overcome different communications barriers: how to communicate about menstruation with girls and women, including those with disabilities, and with men and boys. We have learnt how to make hygiene behaviour change more inclusive and empowering.

What has really changed?

Mickson Jakalasi, drawing water from a disability friendly borehole, Simulemba Health Centre, Kasungu, Malawi, July 2018.
Mickson Jakalasi draws water from a disability-friendly borehole at Simulemba Health Centre, Kasungu, Malawi, July 2018.
Image: WaterAid/Dennis Lupenga

There are many laws, policies and national standards that commit governments to respect, protect and fulfil the human rights to safe water and sanitation. These are supported by a growing body of practical training materials, guidelines and design manuals with tools, checklists, videos and estimates of additional costs. Those of us who have been working to make WASH inclusive for many years can look at these growing resources with satisfaction. We have champions in different organisations. We have produced many nice documents and, together, we have held so many inspiring meetings and webinars.

But what has really changed? Is disability-inclusive WASH the norm? Do WASH programmes always consider gender dimensions – the effects on women and the opportunities for them to take a lead role in decision-making? Do we make sure that people who are marginalised, or politically and financially powerless, have access to WASH?

I often feel that despite the fine words, good intentions and some inspiring pockets of good practice, not much has changed for people who are systematically marginalised and excluded from decent services. In 2019, for example, the World Bank found that only 18% of water utility workers are female.

The biggest barriers

What about me' workshop in Kampot Province, Cambodia, September, 2019.
A 'What about me' workshop in Kampot Province, Cambodia, where people with disabilities raised their concerns about access to toilets. September 2019.
Image: WaterAid/Sokmeng You

The biggest barriers to equality and inclusion in WASH are attitudes and power. Attitudes in society and the attitudes of people working on WASH – us, the professionals, the technical experts who have so much power and control. But the bigger challenge, still, is the way that power operates at local, national and global levels. For that reason, we WASH actors need to recognise the limits of our ability to solve the WASH crisis. We need to learn how to work with people and organisations that directly experience power dynamics, marginalisation and exclusion, and are experts in finding ways to address them. In short, we need more diverse experts.

In Madagascar, for example, WaterAid has worked closely with the National Platform of People with Disabilities, to design inclusive infrastructure and advocate the government to fulfil their commitments to people with disabilities. And in East Africa, WaterAid collaborates with FemNet, the African Women’s Development and Communication Network, to research and raise awareness of the gendered impacts of WASH.

The challenges ahead

So, what should you take from this?

  • Pay close attention to who is included and who is excluded in services and decision making. Think about why certain people are not there. Are those barriers physical or are they about attitudes, power relations and inequalities that are baked into the system?
  • Think about how can you dismantle the barriers. How can you design better infrastructure and services? How can you bring different voices and perspectives into decision making? How can you challenge attitudes that discriminate against certain people? How can you help make duty bearers genuinely accountable to all?
  • Reflect on experiences, skills and perspectives that you can use to tackle the challenges of providing inclusive WASH. And, importantly, recognise what skills you don’t have. Who do you need to work with and learn from to bring about the changes needed?

Working in WASH, we can talk to a disability organisation in Bangladesh one minute and sit at a table with the UN the next. Across the sector, we need to create space for diverse voices to really reveal the barriers, understand them and work together to identify practical solutions. Fighting for inclusive water, sanitation and hygiene takes time, commitment and curiosity. Don’t give up.

This blog is adapted from a keynote speech Louisa Gosling made at the 42nd WEDC international conference in September 2021.

Louisa Gosling worked for WaterAid for more than 13 years, focusing on the application of human rights principles in WASH programmes. Follow Louisa on Twitter @LouisaGosling1.