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sanitation

Incentivizing collaboration to address childhood stunting

Craig Kullmann's picture

Childhood stunting is one of the most significant impediments to human development and economic growth, affecting approximately 155 million children under the age of five globally, with long-term consequences later in life such as impaired cognitive development, chronic disease, and lower earnings as adults. Evidence shows that there is an urgent need for collaboration between actions in water, sanitation, health, nutrition, and other sectors to effectively combat childhood stunting.
 

 
This was discussed during the recent World Bank-IMF Annual Meetings, where leaders from the World Bank and client countries met to talk about Changing Behaviors to Incentivize Collaboration to Address Childhood Stunting. Aimed to provide guidance on how to collaborate better across sectors and institutions, this event provided an opportunity to share the latest results from the global Water Supply, Sanitation, and Hygiene (WASH) Poverty Diagnostic Initiative, led by the World Bank’s Water and Poverty Global Practices in collaboration with the Health, Nutrition, and Population and Governance Global Practices.

“Compressed demand”: How Uttar Pradesh is making sure rural sanitation subsidies for toilets go to the most needy

Arun Kumar Dobhal's picture

When the “Swachh Bharat Mission-Gramin” (SBM-G) was launched in October 2014 with the goal of making rural India free from open defecation by 2019, it gave states and districts more flexibility than previous national sanitation programs had. This led to a successful experiment in Uttar Pradesh called “demand compression”.

The state was preparing to use a tried-and-tested triggering process, where trained motivators concentrate their efforts on a community to help improve their understanding of safe sanitation and stimulate demand for toilets in rural communities where open defecation is still common. However, they faced a problem. If all the households that were eligible for government subsidies would actually claim them, funds would soon run out. With an estimated 15 million households across Uttar Pradesh without a toilet and eligible for a government subsidy of around $200, about $3 billion would be needed.

Household toilet constructed from own resources

Towards a clean India

Guangzhe CHEN's picture

When Prime Minister Narendra Modi launched the Swachh Bharat Mission in 2014, it marked the beginning of the world’s largest ever sanitation drive. Now, a 2017 survey by the Quality Council of India finds that access to toilets by rural households has increased to 62.45 per cent, and that 91 per cent of those who have a toilet, use it. Given India’s size and diversity, it is no surprise that implementation varies widely across states. Even so, the fact that almost every Indian now has sanitation on the mind is a victory by itself.

 Guy Stubbs

Achieving a task of this magnitude will not be easy. Bangladesh took 15 years to become open defecation free (ODF), while Thailand took 40 years to do so. Meeting sanitation targets is not a one-off event. Changing centuries-old habits of open defecation is a complex and long-term undertaking.

When nutrition meets WASH: reflections from Ethiopia and Madagascar on fighting stunting

Claire Chase's picture

Co-author: Sophie Durrans, Research Uptake Officer at London School of Hygiene & Tropical Medicine

A child who is stunted early in life – who fails to grow as tall as expected for their age – often has reduced physical and mental development. Water supply, sanitation, and hygiene (WASH) influences a child's growth in multiple ways. Evidence across low and middle-income countries demonstrates that higher open defecation rates are associated with stunting and higher overall incidence of poverty.

Gender and sex inequalities in water, sanitation, and hygiene

Libbet Loughnan's picture

This blogpost is part of a series of thematic blogs for the World Bank's Water Supply, Sanitation, and Hygiene (WASH) Poverty Diagnostic.

Woman carries water containers near polluted stream and water pipe in Maputo, Mozambique

Addressing gender and sex inequalities in WASH is not only recognized in Sustainable Development Goals (SDGs) 4 and 6, it is central to the entire ambition of the SDGs themselves. Some water, sanitation, and hygiene issues are faced only by women because of their biological sex, whereas others are more influenced by gendered societal norms. To truly leave no one behind, we need to be mindful of and work against gender and sex inequalities in all development work. 
 
New World Bank research is a valuable contribution to doing just that.  ‘Reducing Inequalities in Water Supply, Sanitation, and Hygiene in the Era of the Sustainable Development Goals’ reveals that a drastic change is required in the way countries manage resources and provide key services, starting with better targeting to ensure they reach those most in need.  In many cases, this means women and girls. 

How can we make water and sanitation more inclusive and accessible?

Kamila Anna Galeza's picture

“What’s wrong with this picture?” Louisa Gosling of WaterAid asked the participants at her training on Disability-inclusive Water Operations at the World Bank Water Week in March 2017. She pointed to a photo of a woman standing on the wall of a well. It was round and high, the ground around it muddy, and there was no lifting mechanism in sight.

More pictures followed… latrines and water sources with steep steps, narrow doorways, unstable construction without handles or rails. The more pictures we saw, the clearer it became what was wrong - all the facilities shown were inaccessible and dangerous, quite likely impossible to use for many people. 

Photo Credit: WaterAid

The biggest bang for our limited water and sanitation buck: can investing in small towns lead the way?

Aroha Bahuguna's picture



While the share of poor people in Sub-Saharan Africa decreased from 56 percent in 1990 to 43 percent in 2012, the region’s rapid population growth outpaced the decrease in poverty, resulting in higher number of poor people than before. More specifically, Africa’s urban population is expected to triple in size in the next half century, which is putting pressure on scarce resources in cities, exacerbated by capacity, budget and governance bottlenecks. The densely-populated areas with low levels of water and sanitation services pose a serious threat to public health – cholera epidemics have broken out in urban areas in several African countries in recent years.

Starting life strong in slums: the role of engaging vulnerable groups on sanitation and nutrition

Claire Chase's picture
This blog is co-authored with Lawrence Haddad, Executive Director, The Global Alliance for Improved Nutrition (GAIN)

Other co-authors: 
Beatrice Montesi, GAIN  
Martin P. Gambrill, The World Bank 
Rebecca Jean Gilsdorf, The World Bank

 
Children in a slum in Dhaka, Bangladesh.
Credit: UN Photo/Kibae Park

Crowded slums, poor sanitation and unhealthy diets.  It’s a potent cocktail and for too many families across the world, a daily reality.  Right now, an estimated one billion people live in slums and that number is expected to double by 2030. Slums are where the many deprivations facing the urban poor collide, including lack of access to clean drinking water, sanitation, safe and nutritious foods, sufficient living space, durable housing and secure tenure (UN Habitat).  They’re where human waste is routinely emptied into streets, canals, and garbage dumps. And where overcrowding and low rates of immunization and breastfeeding combine to exacerbate the already perilous problems children face.

Children growing up in these surroundings are at a higher risk of death and disease and are more likely to be chronically malnourished (Ezeh et al. 2017). For example, forthcoming World Bank research from Bangladesh shows that children living in slums are 50 percent more likely to be stunted than children living in other urban areas. This doesn’t just have implications for today - children who are stunted early in life go on to learn and earn less, and face a higher risk of chronic disease as they grow older. Tragically, these effects are often passed on to offspring, trapping families in poverty and malnutrition for generations, as per findings in a forthcoming World Bank report called Uncharted Waters.

Starting a marathon with a broken ankle: how poor water and sanitation sets children behind

Maximilian Leo Hirn's picture
Children in Koutoukalé, Niger

Have you ever wondered how your life chances are affected by where you were born? Odds of being born at all are already miraculously small, but only one in ten of us is born into the relative security of a high-income country. What if you are born in Niger or in the Democratic Republic of the Congo (DRC)? Before you could even walk or talk, your challenges would be daunting. That's because, despite progress, deaths of children under five years old are more than twenty times higher than in the EU and nearly ten times higher than in China.

Even if you survived, you would confront another major risk to your development: malnutrition. In Niger and DRC, almost one out of every two children is stunted. Stunting has significant and long-lasting negative effects on early childhood development, impeding physiological and mental development, and making small children more vulnerable to disease. Starting off in life stunted is akin to starting a marathon with a broken ankle.

Citizen Report Cards for Better Citizen Engagement and Accountability: Sanitation Sector in Egypt

Amal Faltas's picture


Engaging with citizens to obtain their views on the quality of service and the responsiveness of governmental bodies is uncommon in Egypt.

The water and sanitation sector is no exception. Planning and implementation of sanitation projects in Egypt is typically dominated by technical design considerations — with little to no attention to ways in which the community might express its concerns. With an absence of accountability mechanisms to prod government agencies to make improvements, this conventional approach is associated with a weak sense of ownership by local communities and a poor record of delivery of quality infrastructure projects by the government.

But World Bank programs in Egypt are increasingly being designed to incorporate innovative social accountability tools that emphasize the right of citizens to expect quality public services and the responsibility of government to respond to the needs and expectations of citizens. A pioneering effort in this regard within the Bank’s Egypt portfolio is the Sustainable Rural Sanitation Services Program (SRSSP), which integrates a key social accountability tool in its design, namely the Citizen Report Card (CRC).

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