Translating disability inclusive WASH policies into practice: lessons from Cambodia and Bangladesh

Explore our research project with the London School of Hygiene and Tropical Medicine to help improve disability-inclusive and gender-sensitive water, sanitation and hygiene (WASH) policy making in low- and middle-income countries (LMICs) through policy and practice guidance for governments.

One billion people in the world have a disability, and around 80% of them live in LMICs. Many do not have access to WASH services, or have poor quality access. Over the past decade, countries have made progress in tackling discriminatory WASH legal frameworks, but implementing inclusive WASH policies remains a challenge for many. Few efforts to evaluate or document national policies on inclusive WASH exist, nor is there a form of systematic learning that draws together experiences from different countries to determine best practice or identify gaps in inclusive WASH service provision.

To address this, we collaborated with the London School of Hygiene and Tropical Medicine on a research project that aimed to help improve disability-inclusive and gender-sensitive WASH policy making in LMICs through policy and practice guidance for governments.

Using Cambodia and Bangladesh as case studies, the overarching research question we answered was: How can national WASH policies more effectively address the requirements of people with disabilities and their caregivers? Below are the steps we took through the qualitative study and the learning outputs for each.

1. We reviewed Cambodia and Bangladesh's policy documents and evaluated large-scale inclusive WASH interventions. To document the findings, we published two journal articles, with accompanying easy-to-read learning briefs:
   
   Are the rights of people with disabilities included in international guidance on WASH during the COVID-19 pandemic? Content analysis using EquiFrame.
   The Inclusion of Rights of People with Disabilities and Women and Girls in Water, Sanitation, and Hygiene Policy Documents and Programs of Bangladesh and Cambodia: Content Analysis Using EquiFrame.

   To learn about the findings of inclusive WASH in the COVID-19 pandemic, check out this learning brief (PDF).

   To learn about what the study found about WASH policy review in Cambodia and Bangladesh, explore this second learning brief (PDF).

2. We conducted interviews with policy makers at national and district levels, service providers and with people with disabilities and their caregivers to understand their requirements for and access to WASH services. Read more about the findings from these interviews in the learning outputs below.
   
   A qualitative cross-sectional study exploring the implementation of disability-inclusive WASH policy commitments in Svay Reing and Kampong Chhnang Provinces, Cambodia.
   To learn about the study’s findings in Bangladesh, check out the easy to read research report Translating disability-inclusive WASH policies into practice: lessons learned from Bangladesh (PDF) and this research poster (PDF).
   
   Explore a summary of the study’s findings in Cambodia in this learning brief (PDF).
3. We engaged stakeholders, including people with disabilities and their caregivers, to verify findings, reflect on implications and agree key recommendations. We developed practical tools to share the findings, and help guide others in their work.

We developed a disability-inclusive WASH checklist tool (.XLS) for implementers and government officials. Check out this introductory video (download the transcript PDF) and guidance films one (download the transcript PDF) and two (download the transcript PDF).

Local creative rights group in Cambodia, Epic Arts, produced two creative films to capture two thematic study findings, one on the theme of independence and one focussed on caregivers.

This learning brief documents the process followed by the LSHTM to work remotely with the research team in Cambodia to generate qualitative data, analyse, document and disseminate it. The brief records what was learned, the limitations and how these could be addressed in future studies. It includes recommendations for organisations that remotely support non-academics to carry out ethical research in similar settings.