Translating disability-inclusive water, sanitation and hygiene policies into practice in Cambodia and Bangladesh: what do we know? 

How can governments in low- and middle-income countries implement disability-inclusive water, sanitation and hygiene (WASH) at scale? Chelsea Huggett, Jane Wilbur, Rithysangharith Has and Mahfuj-ur Rahman from WaterAid and the London School of Hygiene and Tropical Medicine introduce new joint research into whether and how policy commitments in Cambodia and Bangladesh have been increasing inclusivity of services for people with disabilities. 

People with disabilities often experience greater difficulties in accessing essential water, sanitation and hygiene (WASH) services than do those without. There is a growing focus on improving disability components of WASH policies and services, but how do we know if these policy changes are effective and making a difference? 

WaterAid collaborated with the London School of Hygiene and Tropical (LSHTM) to explore exactly how commitments to disability-inclusive WASH have been made by national governments in Bangladesh and Cambodia, and to what extent these are leading to more inclusive WASH services. The study – Translating disability inclusive WASH policies into practice: lessons learned from Cambodia and Bangladesh (2019–2022) – aimed to develop evidence-based guidance for governments in low- and middle-income countries (LMICs) about implementing disability-inclusive WASH at scale. Our qualitative study reached a total of 65 participants, including 31 people with disabilities.

People with disabilities’ rights to WASH access are often understood but not enacted 

In Bangladesh, we found that Government officials and service providers believed that people with disabilities should have access to WASH services. However, few efforts to improve disability rights included WASH and few WASH activities systematically included disability. Few people with disabilities could access or use WASH services independently at home, meaning they did not bathe or use the toilet as often as they required and when they did use WASH facilities they relied on caregivers.  

Most participants cited affordability as a critical barrier to improving WASH at home. Very few people with disabilities and caregivers were aware of their right to water and sanitation or had demanded them even though structures to do so exist. 

No one ever talks with me or [the person with disabilities]... Nobody talks with us about WASH, sanitation or disability. 

- Caregiver of a woman with a hearing and communication disability, Bangladesh.

In Cambodia, we found that policy commitments to disability-inclusive WASH were strong but were not always enacted systematically at all levels. Organisations of persons with disabilities faced challenges when advocating disability rights at WASH sector meetings and people with disabilities were inconsistently supported to participate in community WASH meetings.  

Poor access to assistive devices (for example wheelchairs) and inaccessible terrain meant few people with disabilities could leave their home and many had inadequate WASH services at home. Caregivers did not have assistive devices (such as commodes or bedpans) or products (such as lifting devices), so supporting WASH for people with disabilities was physically demanding and time consuming. 

Participant: “I want a bigger toilet so that the wheelchair can go in and stuff, but I do not have the money.” 
Researcher: “I see. You do not install a railing?”
Participant: “No, where can I get the money for that when I do not have any money?” 

- Man with a physical disability, Cambodia.

There are gaps in putting WASH policies into practice for people with disabilities 

Our study adds to the growing body of evidence from different LMICs showing that many government officials and service providers consider disability and WASH in silos. Many people with disabilities cannot improve their access to WASH services at the household level and are falling through the gaps.  

All references to disability in WASH-related policies and plans must include clear and concrete activities to achieve them, and efforts must be monitored and evaluated to ensure these are implemented as planned. 

Cross-sectoral collaboration and meaningful participation of people with disabilities 

We have disseminated findings from the research widely in Cambodia and Bangladesh. In Cambodia, five workshops reached more than 300 participants including more than 100 people with disabilities. In Bangladesh, three events reached more than 100 participants including 45 people with disabilities. In Cambodia, we partnered with Epic Arts to develop creative films capturing the research findings, which were disseminated to Government and others.

The workshops increased awareness among duty bearers (including service providers) about WASH access of people with disabilities and caregivers, how it can be improved and the power and value of ensuring people with disabilities are at the front and centre of WASH progress.

The project also led to improved collaboration between WASH, disability and health actors, and increased the meaningful participation of people with disabilities in WASH policy discourse and the identification of solutions. It also enhanced the skills of disability and WASH practitioners with and without disabilities to carry out scientific research.  

Explore our research and learning materials in full

Chelsea Huggett is Equality and Inclusion Technical Lead at WaterAid Australia. Jane Wilbur is Assistant Professor (Disability and WASH) at the International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine. Rithysangharith Has is Equality and Inclusion Program Manager at WaterAid Cambodia and Mahfuj-ur Rahman is Project Manager at WaterAid Bangladesh.

Main image: Due to his disability, Miraj (7) depends on his mother all the time. About 376 children with special needs live in the locality of Pratapnagar, Ashashuni, Shatkhira, Bangladesh.