Changing the way we change the world

WASH can have health impacts beyond reducing diarrhea

By Susan Davis, Executive Director

This week, I participated in the WASH & Neglected Tropical Disease (NTD) Roundtable in London. This is the second such roundtable (the first was in Seattle two years ago). The purpose of this roundtable was to encourage deeper collaboration, coordination, and cooperation between the WASH and NTD organizations and donors, especially in areas of mapping, data collection, monitoring, and research. Interestingly, several of the people attending were from organizations in Atlanta (The Carter Center, Emory University, Children without Worms, Task Force for Global Health, Improve International, etc.)

Being in this piece of the former Roman empire, with its aqueducts and baths, is a reminder that for centuries, humans have recognized the vital roles that access to safe water, toilets, and sewers and practicing good hygiene play in maintaining human health and dignity. Despite this, development professionals still feel obligated to justify investments in water, sanitation, and hygiene (WASH) to donors, often by talking up the health impacts. But demonstration of the actual health impacts mostly focuses just on reduced cases of diarrhea (which is, by the way, notoriously difficult).

The so-called “neglected tropical diseases” (NTDs) are a set of 17 chronic, disabling diseases that disproportionately affect the world’s poorest (and neglected) communities. These diseases are called “neglected” because they receive less attention and less money than diseases such as HIV/AIDs, malaria, and tuberculosis. While the NTDs are rarely fatal, they can be painful and/or cause severe disability.

Not surprisingly, people who live in areas without good water services, or don’t have toilets often are vulnerable to many health problems, especially NTDs. The connection between WASH and NTDs is shown on the map below. Purple shows lower WASH access and more diseases. “Neglected” doesn’t mean “rare”: worldwide, at least one billion people are infected with one or more of the 17 NTDs—and two billion more may be at risk of infection.

WASH & NTDs map


Did you know that controlling and eliminating five of the NTDs also requires WASH?  For example, the “H” in WASH stands for hygiene, yet this often becomes narrowly focused on handwashing. Yet, washing the face and the rest of the body (as most of us with good water services have learned or become accustomed to) can help prevent many diseases. I find it very compelling to think that just by encouraging face washing, you can help stop blindness from trachoma!

Source: WASH and the Neglected Tropical Diseases: A Global Manual for WASH Implementers (Ogden et al, 2013)

Source: WASH and the Neglected Tropical Diseases: A Global Manual for WASH Implementers (Ogden et al, 2013)

To help poor people in developing countries with more of their health issues, WASH implementers and donors must make a concerted effort to target appropriate WASH interventions to communities where NTDs are most prevalent, and slightly modify the best practices for implementation. Collaborative programming with NTD and WASH organizations could also help more people more efficiently. Above all, we need to make sure that water and sanitation services last forever, and we need to vastly improve our hygiene promotion.

For more information and evidence-based practical guidance, visit, where you can find “WASH and the Neglected Tropical Diseases: A Global Manual for WASH Implementers”, specific manuals for several countries, maps, and a free online course.

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